CƠN HEN NẶNG BỘI NHIỄM TRÊN NỀN BỆNH LÝ HẸP KHÍ QUẢN VÀ MỀM SỤN KHÍ QUẢN Ở TRẺ EM: BÁO CÁO CA LÂM SÀNG

Abstract

Recurrent wheezing and acute respiratory distress in children caused by congenital structural airway abnormalities result from the weakness or defect of the supporting cartilaginous rings. Tracheal cartilages are C-shaped structures that help maintain airway patency and stability against fluctuations in negative intrathoracic pressure, thereby preventing dynamic airway collapse at the end of expiration. The intact development of these structures is affected by prematurity and congenital gastrointestinal anomalies (such as esophageal atresia or stenosis), which determine the infant’s ability to maintain adequate ventilation postnatally. These anatomical disorders not only increase airway resistance but also cause secretion retention, leading to severe asthma exacerbations and recurrent pulmonary superinfections. Overall, structural airway pathologies are frequently masked by symptoms mimicking bronchial asthma; this association creates a complex clinical picture characterized by two main aspects: prolonged refractory wheezing and severe respiratory distress progressing from an underlying anatomical abnormality. We describe the clinical presentation and treatment outcomes of a case with a severe, superinfected asthma exacerbation on an underlying background of tracheal stenosis and tracheomalacia. This case emphasizes the necessity of raising awareness regarding structural airway abnormalities in children suffering from respiratory diseases. Early recognition of these congenital defects is crucial for improving patient outcomes, avoiding ineffective treatments, and preventing corticosteroid overuse. While tracheal stenosis reduces the fixed airway caliber, predisposing the patient to infections and sputum retention, tracheomalacia causes expiratory tracheal collapse, thereby manifesting with asthma-like symptoms (wheezing, air trapping, hypoventilation).