Flexible Bronchoscopy and Pediatric Asthma

The role of flexible bronchoscopy in the management of pediatric asthma is not defined by the guidelines. However, flexible bronchoscopy plays an important role in the differential diagnosis of pediatric wheezing. Flexible bronchoscopy together with bronchoalveolar lavage and endobronchial biopsy allows for the assessment of anatomical airway abnormalities and characterization of airway inflammation in children with severe uncontrolled asthma. In this chapter, several bronchoscopy-based phenotypes of severe uncontrolled asthma, specifically “persistent airway eosinophilia,” “airway remodeling,” “severe uncontrolled asthma/bacterial bronchitis overlap,” and “severe uncontrolled asthma/esophagitis” are described. Practical approach to the management of severe uncontrolled asthma via phenotype-based individualized management plans is suggested.