This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Chronic aspiration of saliva causes permanent lung injury due to the persistent accumulation of oral microbes and enzymes stimulating chronic airway inflammation. There is no gold standard test for the diagnosis of salivary aspiration and the diagnosis currently depends on the combination of a suggestive history and physical exam coupled with a positive diagnostic test. Current tests for salivary aspiration evaluate children for aspiration at a single point in time. Identification of oral flora on culture of bronchoalveolar lavage fluid (BAL) may also signify aspiration of saliva and may have an advantage by reflecting accumulation of oral contents in the lower airways over time. Quantitative BAL cultures for oral flora are widely available but have not been evaluated as a test for aspiration. The purpose of this pilot study is to evaluate quantitative BAL culture as a novel test for the diagnosis of salivary aspiration by determining its ability to prospectively differentiate between children clinically diagnosed with chronic salivary aspiration and controls. Amongst children undergoing clinically indicated flexible bronchosocpy with BAL, subjects are enrolled as cases of salivary aspiration based on a combination of risk factors involving symptomatology, underlying diagnoses, and a positive diagnostic test. Controls are those undergoing bronchoscopy strictly for evaluation of structural airway lesions. Quantitative cultures of BAL for oral flora are compared between these two groups and are correlated to a semi-quantitative score of lung injury by CT scan.
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