Based on the high risk for recurrent episodes of bronchitis and/or
pneumonia in EA-TEF, the RCWG strongly recommended that chronic wet
cough should be evaluated for underlying undiagnosed anatomic and/or
functional abnormalities. The main evaluation includes a CT scan to
determine the presence of chronic changes such as
bronchiectasis47,50, and a BAL to determine presence
of colonization with bacterial and other pathogens as well as for
evidence of aspiration(see also section V for the evaluation of
aspiration). The threshold for repeating the investigations should be
low because there is evidence that airway inflammation, bacterial
bronchitis, and bronchiectasis may be present in young children with
EA/TEF even when they are asymptomatic9,45,65,107,108.
However, for patients with an established pattern it is not necessary to
repeat the work-up for every exacerbation unless there is suspicion of
new pathology. A CXR with each suspected episode of pneumonia may be
useful to document how often a patient is having lobar pneumonia, which
may, in turn, determine the necessity for further investigations.