Management Of Plastic Bronchitis Using Alpha-Chymotrypsin: A Novel Treatment Modality

Plastic bronchitis (PB) is a rare pediatric respiratory disease, characterized by the formation of obstructive casts in the bronchial tract that causes partial or extensive airway obstruction, leading to obstructive dyspnea mimicking a foreign body in the trachea. The clinical presentation and radiologic examination of plastic bronchitis are nonspecific, and the confirmation of the diagnosis is only possible via the direct observation of the casts via bronchoscopy or expectorating. So far, no effective treatment for PB has been demonstrated in controlled clinical trials, and presently, there are no reports regarding the use of alpha-chymotrypsin as a treatment modality. alpha-Chymotrypsin, as a mucolytic agent, liquefies the mucus and decreases the viscosity of sputum by acting directly on mucus. Here, we report a PB case that is associated with influenza A virus infection, developing in an eight-year-old boy. The diagnosis of PB was confirmed via cast observation following its removal via bronchoscopy. Specifically, the casts were successfully removed via bronchoscopy coupled with endotracheal instilled alpha-chymotrypsin. Thereafter, the patient gradually improved and successfully extubated. In the clinical follow-up, the patient was asymptomatic and without recurrent casts. Therefore, alpha-chymotrypsin may be one modality of treatment to remove casts in PB.