What are the statistics on foreign bodies in the bronchi (bronchial tubes)?

Statistics of Foreign Bodies in Bronchi

Foreign body aspiration into the bronchi is a significant clinical concern, particularly in children, with potential for serious complications including pneumonia, atelectasis, and bronchiectasis if diagnosis is delayed beyond 30 days.

Epidemiology and Demographics

• Foreign body aspiration is a common indication for bronchoscopy in children 1
• In adults, occult bronchial foreign bodies (OBFB) are rare:
  • Approximately 4 per 10,000 hospitalizations
  • 8 per 10,000 bronchoscopies
  • Hospitalization rate of 0.07 per 100,000 adult inhabitants/year 2
• Approximately one-third of patients present with less prominent symptoms (occult bronchial foreign bodies) 2

Types of Foreign Bodies

• Organic materials are common, particularly in children:
  • Food items (especially nuts, seeds)
  • Bone fragments (5 cases in one study) 2
  • Vegetable matter (garlic cloves, corn) 2
• Inorganic materials:
  • Plastic objects 3, 4
  • Metallic objects (e.g., whistle) 5
  • Wooden items 2

Clinical Presentation

• Acute presentation:

  • Cough (most common symptom)
  • Wheezing
  • Stridor
  • Respiratory distress

• Delayed/occult presentation:

  • Recurrent pneumonia
  • Persistent cough
  • Fever
  • Atelectasis (5 cases in one study) 2
  • Purulent pneumonia (3 cases) 2
  • Pleural empyema (1 case) 2
  • Some patients may be completely asymptomatic 4

Complications

• Risk of long-term complications increases with time to diagnosis:
  • Up to 60% complication rate when diagnosis is delayed >30 days 6
  • Bronchiectasis occurs in 25% of patients with diagnosis delayed >30 days 6
  • Some patients require lobectomy due to irreversible bronchiectasis 6
  • Persistent asthma-like symptoms (cough, wheezing) may develop 6
  • Plant material can mimic bronchial tumors in imaging (4 cases in one study) 2

Diagnostic Approach

• High-resolution CT scan is recommended for suspected foreign body aspiration 1
• Flexible bronchoscopy is diagnostic in most cases and can identify:
  • Location of the foreign body
  • Associated inflammation or granulation tissue
  • Airway dynamics 1
• Rigid bronchoscopy is the gold standard for both diagnosis and removal of foreign bodies 1

Management

• Removal techniques:
  • Rigid bronchoscopy is preferred for removal of foreign bodies in children 1
  • Flexible bronchoscopy can be successful in 11 of 12 patients in one adult series 2
  • Surgical intervention is rarely needed (1 in 12 cases in one series) 2

Important Clinical Pitfalls

1. Missed diagnosis: Foreign bodies may be overlooked, especially when:

   • There is no witnessed aspiration event
   • The patient is asymptomatic or has minimal symptoms
   • Radiographic findings are normal or nonspecific

2. Misdiagnosis: Foreign bodies can mimic other conditions:

   • Bronchogenic carcinoma, especially with plant material 2, 3
   • Asthma or recurrent bronchitis

3. Delayed complications: Even after successful removal, patients may develop:

   • Transient bronchial hyperresponsiveness requiring inhaled corticosteroids 6
   • Permanent structural changes if diagnosis was significantly delayed

Prevention and Follow-up

• Close supervision of young children during meals and play
• Long-term follow-up is recommended after foreign body removal to monitor for:
  • Resolution of symptoms
  • Development of bronchiectasis or other complications
  • Need for additional interventions

The prognosis is generally excellent with prompt diagnosis and removal, but worsens significantly when diagnosis is delayed beyond 30 days 6.