Pediatric Pulmonology 34:30–36 (2002) Foreign Body Aspiration: What Is the Outcome? Fazilet Karakoc ¸, MD, 1 * Bu ¨ lent Karadag ˘, MD, 1 Cengiz Akbenliog ˘ lu, MD, 1 Refika Ersu, MD, 1 Bedrettin Yıldızeli, MD, 2 Mustafa Yu ¨ ksel, MD, 2 and Elif Dag ˘ lı, MD 1 Summary. Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. We reviewed a total of 174 children with foreign body aspiration (FBA). Clinical, radiological, and bronchoscopic findings of these patients were evaluated according to the nature of foreign body and elapsed time from aspiration to diagnosis. Significant differences were noted between patients with organic and inorganic FBA in terms of clinical and radiological findings. Cough, recurrent pneumonia, and fever were the most common presenting symptoms in patients with delayed diagnosis. Long-term follow-up was available for 110 patients for a mean duration of 37.8  23.7 months (range, 1 – 88 months). We evaluated the course of recovery after bronchoscopic removal. Organic FBA was of comparable duration as for inorganic FBA, and prolonged follow-up was associated with increased risk of persistent symptoms and bronchiectasis (P < 0.001). The risk of long-term complications increased with increasing elapsed time from aspiration to diagnosis; complications were as high as 60% in children who were diagnosed 30 days after FBA (P ¼ 0.0035). Bronchiectasis was a major complication, found in 25% of patients whose diagnosis was delayed by more than 30 days (P ¼ 0.0001). Three patients with bronchiectasis underwent lobectomy. Patients with persistent asthma-like symptoms such as cough and wheezing required treatment with inhaled corticoste- roids and bronchodilators. The positive response to this treatment was thought to be a confir- mation of the development of transient bronchial hyperresponsiveness induced by foreign bodies. We conclude that timely diagnosis and appropriate treatment of FBA is important to prevent long-term complications in affected children. Pediatr Pulmonol. 2002; 34:30–36. ß 2002 Wiley-Liss, Inc. Key words: foreign body aspiration; children; long-term complications; bronchial hyperresponsiveness; pneumonia; atelectasis; bronchiectasis; wheezing. INTRODUCTION Foreign body aspiration (FBA) is a common cause of morbidity and mortality in children, especially between ages 18 months to 3 years. Inhalation of a foreign body (FB) into the respiratory tract may result in an acute life- threatening obstruction. More than 300 deaths per year occur as a result of FBA in the United States. 1 Undiagnosed, retained foreign bodies may also cause serious complications like pneumonia, wheezing, bronchiectasis, or atelectasis. A high index of suspicion is generally required to avoid significant morbidity and mortality. 2–4 Although most children with FBA have complete re- covery after removal of the foreign body, some children (especially with delayed diagnosis) may have a complica- ted course of recovery associated with persistent respira- tory symptoms such as cough and wheezing or prolonged hospital stays. Most of these events are related to the inflammatory process initiated by the FB. 4,5 There have been very few data about the follow-up of patients with FBA, after bronchoscopic removal of the FB. The specific aims of this study were: 1) to describe the clinical find- ings and visual assessment of mucosal changes in relation to the elapsed time from aspiration to diagnosis of FBA; 2) to identify the differences between organic and inorganic FBA in terms of clinical findings and long-term complications; 3) to evaluate the relationship betwen long-term complications and elapsed time from aspira- tion to diagnosis, and the mucosal changes on bronchos- copic examination; and 4) to observe the course of recovery with antiinflammatory treatment after bronchoscopic removal of the FB. MATERIALS AND METHODS This retrospective study included 174 children who were treated for FBA at Marmara University Hospital, 1 Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey. 2 Department of Thoracic Surgery, Marmara University, Istanbul, Turkey. *Correspondence to: Fazilet Karakoc ¸, M.D., Hu ¨rriyet Mah. Dr. Cemil Bengu ¨ Cad., No. 103/A, 80340 S ¸is ¸ li-Istanbul, Turkey. Received 10 January 2001; Accepted 4 December 2001. DOI 10.1002/ppul.10094 Published online in Wiley InterScience (www.interscience.wiley.com). ß 2002 Wiley-Liss, Inc.