A 3-year-old with acute onset of cough and wheeze. Focal wheezing in the right lower lobe. Which is the most effective treatment for suspected foreign body aspiration?

A 3-year-old with acute onset of cough and wheeze. Focal wheezing in the right lower lobe. Which is the most effective treatment for suspected foreign body aspiration?

• A. Albuterol
• B. Azithromycin
• C. Bronchoscopy
• D. Chest physiotherapy

Answer: (C)

Suspected foreign body aspiration in a young child is a mechanical airway obstruction, so the priority is to visualize and remove the object rather than treat with bronchodilators or antibiotics. The best next step is bronchoscopy, typically rigid bronchoscopy in children, because it provides direct airway visualization, secures the airway, and allows grasping and extraction of the foreign body in one procedure. This approach offers both diagnostic confirmation and immediate therapeutic removal, which is crucial in acute unilateral wheeze. Using a bronchodilator might transiently improve wheeze if there’s a reactive component, but it doesn’t address the obstruction and can delay definitive management. Antibiotics are unnecessary unless there’s evidence of infection. Chest physiotherapy isn’t appropriate for foreign bodies; it won’t reliably remove the object and could worsen obstruction or cause injury.

Suspected foreign body aspiration in a young child is a mechanical airway obstruction, so the priority is to visualize and remove the object rather than treat with bronchodilators or antibiotics. The best next step is bronchoscopy, typically rigid bronchoscopy in children, because it provides direct airway visualization, secures the airway, and allows grasping and extraction of the foreign body in one procedure. This approach offers both diagnostic confirmation and immediate therapeutic removal, which is crucial in acute unilateral wheeze.

Using a bronchodilator might transiently improve wheeze if there’s a reactive component, but it doesn’t address the obstruction and can delay definitive management. Antibiotics are unnecessary unless there’s evidence of infection. Chest physiotherapy isn’t appropriate for foreign bodies; it won’t reliably remove the object and could worsen obstruction or cause injury.