Right middle lobe atelectasis in children with asthma and prognostic factors

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Background: Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the characteristics of RML atelectasis in asthma during childhood. Methods: Children with asthma who had recently developed RML atelectasis were included; antiinflammatory medications, clarithromycin, and inhaled salbutamol were prescribed, chestphysiotherapy (starting on the sixth day) was applied. Patients were reevaluated on the sixth, fourteenth, thirtieth, and ninetieth days, chest X-rays were taken if the atelectasis had not resolved at the time of the previous visit. Results: Twenty-seven patients (6.8 (4.8-8.3) years, 48.1% male) with RML atelectasis were included. Symptoms started 15 (7-30) days before admission. The thickness of the atelectasis was 11.8±5.8 mm; FEV₁% was 75.9±14.2 and Childhood Asthma Control Test scores were 11.8±5.6 at the time of admission. The atelectasis had been resolved by the sixth (n=3), fourteenth (n=9), thirtieth (n=10), and ninetieth days (n=3). The treatment response of the patients whose atelectasis resolved in fourteen days was better on the sixth-day (atelectasis thickness: 4.7±1.7 vs. 11.9±7.3 mm, p=0.021) compared to those whose atelectasis resolved later. Nearly half (54.5%) of the patients whose atelectasis had resolved by fourteen days were using controller medications at the time of admission. However, only two patients (13.3%) were on controller treatment in the latter group (p=0.032). Regression analysis didn't reveal any prognostic factors for the early resolution of atelectasis. Conclusions: Early diagnosis and treatment of RML atelectasis prevents complications. Patients who had early resolution of atelectasis had already been on anti-inflammatory medications, and responded better to aggressive treatment within the first week.