Chest
Volume 122, Issue 3, September 2002, Pages 791-797
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Clinical Investigations
Asthma
Bronchoalveolar Cells in Children < 3 Years Old With Severe Recurrent Wheezing

https://doi.org/10.1378/chest.122.3.791Get rights and content

Study objective

To determine the cell profile of BAL from infants with severe recurrent wheezing who were not acutely ill at the time of investigation, suggesting an ongoing inflammation.

Design and patients

In a retrospective study, we determined BAL cell profiles for 83 children with wheezing aged 4 to 32 months (mean ± SD, 11.3 ± 5.5 months). Fiberoptic bronchoscopy was performed in children with severe recurrent wheezy bronchitis unresponsive to inhaled steroids. These children were compared with 17 children aged 6 to 36 months (mean, 15.1 ± 7.5 months) with various nonwheezing pulmonary diseases. Children were included as control subjects if they had no endobronchial inflammation and no atopy.

Results

The BAL cell profile of young children with wheezing typically includes a significantly higher cell count (mean, 644.4 ± 956.8 × 103/mL vs 313 ± 203.2 × 103/mL, p = 0.008), a significantly higher percentage of neutrophils (mean, 9 ± 12.1% vs 2.1 ± 2.2%, p = 0.003), and a higher neutrophil count (mean, 43.2 ± 81.6 × 103/mL vs 7.9 ± 11.8 × 103/mL, p = 0.003), as compared with control subjects. The larger number of neutrophils in children with wheezing was not correlated with bacterial or viral infection, or with age, sex, or atopic status. In contrast to the situation in asthmatic adults, eosinophil levels were not higher in children with wheezing than in control subjects (mean, 0.09 ± 0.27% vs 0.08 ± 0.25%).

Conclusion

Neutrophil-mediated inflammation in the airways appears to better characterize severe recurrent wheezing in children < 3 years old.

Section snippets

Materials and Methods

Demographic and clinical data were obtained by retrospective review of the patients’ medical records.

FB Findings

FB and BAL were well tolerated by children with wheezing and control subjects, and no major complications were observed. For the 83 children with wheezing, bronchoscopy results were normal in 36 children and mild airway inflammation (erythema) was detected in 43 children. Airway morphology was abnormal in the four remaining children with wheezing: slight laryngomalacia (n = 2) and moderate anterior compression of the trachea (n = 2). These four children were retained in the analysis because

Discussion

Little is known about cell profile in normal young children and in infants with recurrent wheezing (Table 2). This series of 83 infants with wheezing constitutes the largest reported. Our indications for bronchoscopy were very restrictive. In each case, bronchoscopy was used in search of airways abnormalities in children with severe recurrent wheezing, as recommended by other authors.1516 BAL was carried out according to the recommendations of the European Respiratory Society.14 One possible

Conclusion

This study was carried out with a large series of children with severe recurrent wheezing. The high level of neutrophils and the normal number of eosinophils in the BAL seem to be specific in children of this age group with severe respiratory symptoms. These features confirm the presence of inflammation outside an acute episode. This high level of neutrophils does not seem to be associated with the quality of collection or the presence of a bacterial or viral infection. Our results suggest that

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