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Paediatric lung disease

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1L Tsartsali, 2AA Hisslop, 3K McKay, 4J Zhu, 4PK Jeffery, 1A Bush, 1S Saglani. 1Department of Respiratory Paediatrics, Royal Brompton Hospital, Imperial College, London, UK, 2Developmental Vascular Biology, UCL Institute of Child Health, London, UK, 3Department of Respiratory Medicine, The Children’s Hospital, Westmead, Australia, 4Department of Gene Therapy, Royal Brompton Hospital, Imperial College, London, UK

Background: Abnormal thickening of the bronchial subepithelial reticular basement membrane (RBM) is a recognised feature of airway remodelling.13 However, even although the RBM is present in the airways of healthy children and adults, nothing is known about its normal development. We hypothesised that the RBM is first visible at birth and subsequently thickens normally with age for the first 3 years, when final adult thickness is reached.

Methods: Cartilaginous airways were studied in lungs obtained postmortem from 87 infants and children (22 weeks gestation to 17 years old) who had died from non-respiratory causes and had no history of asthma. RBM thickness was measured in haematoxylin and eosin stained paraffin wax sections using computer aided image analysis and a method previously validated in endobronchial biopsies.4

Results: The RBM was first visible at 30 weeks gestation (28–34 weeks gestation, median (range) RBM thickness 1.1 μm (0–1.68)), and thickened rapidly during the first 3 years of life (fig). Subsequently it continued to thicken at a slower rate until 17 years (15–17 years old, median RBM thickness 5.78 μm (4.89–6.68)). From 6 years onwards, there was large biological variability in RBM thickness, which may explain why no plateau was seen as expected. RBM thickness was related to both weight and height of subjects (Spearman’s r  =  0.729, p<0.001 and r  =  0.725, p<0.001) and increased with increasing airway size (Spearman’s r  =  0.357, …

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    BMJ Publishing Group Ltd and British Thoracic Society