Overview of Plastic Bronchitis in Pediatric Patients

Overview of Plastic Bronchitis in Pediatric Patients

Plastic bronchitis (PB) is a rare and serious condition characterized by the formation of gelatinous airway casts that can obstruct airflow and lead to significant respiratory distress in children. It is often seen in association with underlying medical conditions, particularly congenital heart disease and respiratory infections such as Mycoplasma pneumoniae pneumonia (MPP) (Huang et al., 2025). In pediatric populations, the development of PB can result in life-threatening complications, particularly due to the unique anatomical and physiological characteristics of children’s airways.

The pathophysiology of PB involves an interplay of factors that lead to excessive mucus production and the formation of these casts. This condition can manifest as a complication of infectious processes, inflammatory responses, or anatomical abnormalities. The clinical presentation may include a chronic cough, wheezing, difficulty breathing, and expectoration of the casts, which can severely impact the quality of life and necessitate urgent medical intervention (Zhao et al., 2022).

Key Symptoms and Diagnostic Approaches for Plastic Bronchitis

Children with PB typically present with respiratory symptoms that may include:

• Chronic cough: Often nonproductive, but can progress to expectoration of casts.
• Dyspnea: Difficulty breathing, which may be exacerbated by physical activity.
• Wheezing: Particularly during expiration, due to airway obstruction.
• Cyanosis: A bluish tint to the skin, indicating reduced oxygen saturation.
• Fever: Especially if there is an underlying infection such as pneumonia.

Diagnosis of PB is primarily made through clinical evaluation and imaging studies. A thorough history and physical examination are essential to assess the presence of respiratory distress and other associated symptoms. Imaging studies such as chest X-rays or CT scans can reveal the presence of airway casts and help rule out other causes of respiratory symptoms, such as pneumonia or atelectasis (Zhao & Zhang, 2025).

Bronchoscopy is often utilized as both a diagnostic and therapeutic tool. It allows direct visualization of the airway and the removal of obstructive casts. In cases where casts are present, bronchoscopy can provide immediate relief from symptoms (Huang et al., 2025).

Treatment Options: From Medications to Surgical Interventions

The management of plastic bronchitis in children involves a multifaceted approach, often tailored to the underlying cause and the severity of symptoms. Key treatment options include:

1. Bronchodilators: Medications such as albuterol or ipratropium may be used to relieve bronchospasm and improve airflow.
2. Mucolytics: Agents like N-acetylcysteine can help thin mucus secretions, making it easier for the child to expectorate.
3. Corticosteroids: These may be prescribed to reduce inflammation in the airways, particularly in cases associated with significant bronchial inflammation.
4. Antibiotics: If there is an underlying bacterial infection contributing to PB, appropriate antibiotics should be initiated (Huang et al., 2025).
5. Bronchoscopy: This procedure is often essential for both diagnosis and management, allowing for the direct removal of casts obstructing the airways (Zhao et al., 2022).
6. Surgical Intervention: In cases where conservative management fails, surgical options such as stenting or reconstruction of affected airways may be considered.

The Role of Comorbid Conditions in Plastic Bronchitis Outcomes

The presence of comorbid conditions can significantly influence the outcomes of children with plastic bronchitis. Conditions such as congenital heart defects, particularly those requiring surgical intervention like the Fontan procedure, can predispose children to PB due to altered hemodynamics and lymphatic drainage issues (Kołcz et al., 2025). Other factors such as obesity, asthma, and chronic respiratory diseases can contribute to a higher burden of disease and complicate treatment (Zhao et al., 2022).

Additionally, infections with Mycoplasma pneumoniae are particularly notable for their association with PB. Research suggests that children with MPP are at a higher risk for developing PB due to the inflammatory responses triggered by the infection, which can lead to increased mucus production and subsequent cast formation (Huang et al., 2025).

Future Directions in Research and Management of Plastic Bronchitis

The management of plastic bronchitis is evolving as new research sheds light on its pathophysiology and treatment options. Future studies should focus on:

• Longitudinal Studies: Investigating the long-term outcomes of children with PB, particularly those with underlying conditions like congenital heart disease.
• Novel Therapeutics: Exploring the efficacy of new medications and treatment approaches, including targeted therapies for specific pathogens like Mycoplasma pneumoniae.
• Enhanced Imaging Techniques: Utilizing advanced imaging modalities to better assess lymphatic function and guide interventions.
• Patient-Centric Approaches: Developing management strategies that consider the psychosocial aspects of living with chronic respiratory conditions.

FAQ

What is plastic bronchitis? Plastic bronchitis is a rare respiratory condition characterized by the formation of gelatinous airway casts that obstruct airflow, leading to significant respiratory distress.

What are the common symptoms of plastic bronchitis in children? Common symptoms include chronic cough, difficulty breathing (dyspnea), wheezing, cyanosis, and fever.

How is plastic bronchitis diagnosed? Diagnosis typically involves a clinical evaluation, imaging studies (like chest X-rays or CT scans), and bronchoscopy to visualize and potentially remove airway casts.

What are the treatment options for plastic bronchitis? Treatment options may include bronchodilators, mucolytics, corticosteroids, antibiotics, and bronchoscopy. In severe cases, surgical interventions may be necessary.

Can plastic bronchitis be prevented? Preventive strategies include managing underlying conditions, prompt treatment of respiratory infections, and regular follow-up for at-risk children.

References

1. Huang, X., & Zhang, D. (2025). Neutrophils are involved in the development and outcomes of plastic bronchitis associated with Mycoplasma pneumoniae pneumonia. https://doi.org/10.1186/s12931-025-03167-z
2. Zhao, L., & Zhang, T. (2022). Development and validation of a nomogram to predict plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia. https://doi.org/10.1186/s12890-022-02047-2
3. Kołcz, J., Adamczyk, K., & Rudek-Budzyńska, A. (2025). Hraska procedure for failing Fontan circulation. https://doi.org/10.5114/kitp.2025.148509
4. Xuan, W. et al. (2025). Impact of body mass index on clinical outcomes in pediatric patients with mycoplasma pneumoniae pneumonia: a retrospective cohort study. https://pubmed.ncbi.nlm.nih.gov/12079697/
5. Wei, J., Zeng, L., Huang, Y., Liao, J., Liu, E., & Zang, N. (2025). Research progress on human adenovirus sepsis