Clinical, laboratory, and radiological characteristics of lung damage in pediatric patients hospitalized with bronchial asthma and bronchiectasis

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Abstract
Undiagnosed comorbid conditions are a common cause of difficulty in achieving control of bronchial asthma (BA). One of the comorbid conditions in asthma is bronchiectasis (BE). Objective . To characterize clinical, laboratory, and radiological features of lung damage in children hospitalized for asthma and BE. Materials and methods. Patients with asthma and BA were observed at the Morozovskaya Children’s City Clinical Hospital from January 2023 to July 2025. The criteria for inclusion in the study were pediatric age, confirmed asthma, and the presence of BE unrelated to cystic fibrosis. The following diagnostic tools were used: analysis of clinical history, allergology and immunology tests, radiography, thoracic computed tomography, fiberoptic bronchoscopy with microbiological examination of bronchoalveolar lavage fluid, pulmonary function test, as well as the study of ciliary motility, and genetic tests. Results . In the period from January 1, 2023 to July 1, 2025 19 children with asthma and BE admitted to the Department of Pulmonology at the Morozovskaya Children’s City Clinical Hospital accounted for 1,4% of all children with asthma hospitalized during this period (19/1392). There were 10 (53%) male patients with asthma and BE; at the moment of admission, the median age of patients was 9.0 [7.0; 11.0] years; the median age at the onset of asthma was 1,5 [0.54; 2.0] years, asthma duration was 8,0 [5.5; 10.0] years, while the median length diagnostic delay was 5,5 [2.75; 8.5] years. Upon admission, 17 (89%) children reported a decrease in exercise tolerance, 15 (79%) — shortness of breath, 10 (53%) — dry cough; 6 (32%) patients had dry wheezing, 3 (16%) — wheezing. The levels of eosinophils and monocytes were respectively 0,22 [0.07; 0.34] and 0,42 [0.33; 0.46] cl/ml; median forced expiratory volume in 1 sec. was 80,0 [47.0; 89.0]%. A positive family history of allergy was present in 12 (63%) patients, concomitant allergic rhinitis in 10 (53%), and atopic dermatitis in 6 (32%). Primary ciliary dyskinesia was confirmed in 2 (11%) patients, while atopic asthma prevailed in 15 (79%), and non-atopic asthma in 4 (21%). At the time of enrollment, 13 (68%) patients had moderate asthma, 3 (16%) mild asthma, and 3 (16%) severe asthma; 6 (32%) patients had partially controlled asthma, and 4 (21%) uncontrolled asthma; 10 (53%) patients were hospitalized for asthma exacerbation. Chest CT scans revealed BE in the middle lobe of the right and/or lingual segments of the left lung in 13 (69%) patients, while 14 (74%) patients had traction BE. The majority of patients (13/16) had purulent endobronchitis. The most common pathogen detected in the culture of bronchoalveolar lavage fluid was H. influenzae. Conclusion . A single-center study was conducted to characterize the clinical, laboratory and radiological outcomes in pediatric patients hospitalized with asthma and BA.

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