Flexible bronchoscopy and BAL:
Informed consent for the procedure was obtained from parents/guardians of patients before each bronchoscopy, which were all clinically indicated as part of the patients’ evaluations for persistent wheezing. The bronchoscopies were done under inhalational anesthesia. The BAL was obtained from the right middle lobe unless otherwise prompted by more inflammation in other anatomical locations. We used a maximum of three aliquots of 10 ml each. The three aliquots were pooled and sent as one sample for analysis and culture (bacterial, viral). The 2.8mm (Olympus XP 160) pediatric flexible fiberoptic bronchoscope was used in all procedures. The scope was introduced through a laryngeal airway to reduce contamination of the bronchoscope with naso-oropharyngeal flora.