The readers’ interest in our article deserves appreciation as the questions raised by them provide us an opportunity to clarify common issues related to the management of tracheomalacia [1].

Ours was a retrospective study and the study population included cases referred from various centers. As gastroesophageal reflux (GER) is also otherwise common among infants, this information was not collected in the study. Bronchoalveolar lavage (BAL) is one of the useful investigations done with a bronchoscope. We did not include BAL findings with our report because of the need for brevity.

In congenital airway malacias, due to defective cartilage support, the contour of airways is maintained by the bronchial smooth muscle. Such infants when presenting with wheeze may not improve with beta-agonist nebulization. At times the wheeze worsens due to a reduction in the muscle tone caused by beta-agonists where semisynthetic anticholinergics may help. Appropriate antibiotics, ipratropium nebulization, chest physiotherapy, and noninvasive ventilation may improve the morbidity of the affected infants. Tracheomalacia is often self-limited and will resolve or become asymptomatic by the second year of life without intervention [3].

1. Vijayasekaran D, Balasubramanian S, Sivabalan S, Vindhiya K. Clinical characteristics and associated congenital lesions with tracheomalacia in infants. Indian Pediatr. 2018;55:883-4.

2. Pan W, Peng D, Luo J, Liu E, Luo Z, Dai J, et al. Clinical features of airway malacia in children: A retrospective analysis of 459 patients. Int J Clin Exp Med. 2014;7: 3005-12.

3. Snijders D, Barbato A. An update on diagnosis of tracheomalacia in children. Eur J Pediatr Surg. 2015;25:333-5.