G Lezmi1,2, A Deschildre3, R Abou Taam1, M Fayon4,5, S Blanchon6, F Troussier7, P Mallinger8, B Mahut9, P Gosset10,11,12,13, J de Blic1,2. 1. Service de Pneumologie et Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France. 2. Université Paris Descartes, Paris, France. 3. Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU de Lille, Université Nord de France, Lille, France. 4. Centre de Recherche Cardio-thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France. 5. CHU de Bordeaux, Centre d'Investigation Clinique (CIC 1401), Bordeaux, France. 6. Unité de Pneumologie et Allergologie Pédiatrique, Centre de Compétences des Maladies Respiratoires Rares, Hôpitaux Universitaire de Toulouse, Toulouse, France. 7. Centre de Ressources et de Compétences en Mucoviscidose Enfants, Service de Pédiatrie, Centre Hospitalier Universitaire, Angers, France. 8. Cabinet de Pneumologie et d'Allergologie des Sardières, Bourg-en-Bresse, France. 9. Cabinet La Berma, Antony, France. 10. Centre d'Infection et d'Immunité de Lille, Institut Pasteur de Lille, Lille, France. 11. Centre National de la Recherche Scientifique, Lille, France. 12. Institut National de la Santé et de la Recherche Médicale, Lille, France. 13. Institut Fédératif de la Recherche 142, Lille, France.
Abstract
BACKGROUND: The influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood. OBJECTIVE: To assess their association with asthma symptoms and lung function at school age. METHODS: Preschoolers (38.4 months) initially investigated with bronchial biopsies were re-assessed for asthma symptoms and lung function at school age. RESULTS: Thirty-six of 49 preschoolers (73.5%) were assessed at 10.9 years. Twenty-six (72.2%) had persistent asthma. Submucosal eosinophil counts were higher in children with severe exacerbations at school age than in those without (16/0.1 mm2 [11.2-30.4] vs 8/0.1 mm2 [2.4-17.6], P = .02), and correlated with the number of severe exacerbations (P = .04, r = .35). Submucosal neutrophil counts correlated with FEV1/FVC (P < .01, r = .47) and FEF25-75% predicted (P = .02, r = .43). Airway smooth muscle (ASM) area correlated with FEV1/FVC (P < .01, r = .51). Vessel numbers negatively correlated with FEV1% predicted and FEV1/FVC (P = .03, r = -.42; P = .04, r = -.41; respectively) and FEF25-75% predicted (P = .02, r = -.46). CONCLUSION: Eosinophilic inflammation in preschoolers with severe recurrent wheeze might be predictive of future severe exacerbations, neutrophilia might be associated with better lung function. Changes in ASM and vascularity might affect lung function at school age.
BACKGROUND: The influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood. OBJECTIVE: To assess their association with asthma symptoms and lung function at school age. METHODS: Preschoolers (38.4 months) initially investigated with bronchial biopsies were re-assessed for asthma symptoms and lung function at school age. RESULTS: Thirty-six of 49 preschoolers (73.5%) were assessed at 10.9 years. Twenty-six (72.2%) had persistent asthma. Submucosal eosinophil counts were higher in children with severe exacerbations at school age than in those without (16/0.1 mm2 [11.2-30.4] vs 8/0.1 mm2 [2.4-17.6], P = .02), and correlated with the number of severe exacerbations (P = .04, r = .35). Submucosal neutrophil counts correlated with FEV1/FVC (P < .01, r = .47) and FEF25-75% predicted (P = .02, r = .43). Airway smooth muscle (ASM) area correlated with FEV1/FVC (P < .01, r = .51). Vessel numbers negatively correlated with FEV1% predicted and FEV1/FVC (P = .03, r = -.42; P = .04, r = -.41; respectively) and FEF25-75% predicted (P = .02, r = -.46). CONCLUSION:Eosinophilic inflammation in preschoolers with severe recurrent wheeze might be predictive of future severe exacerbations, neutrophilia might be associated with better lung function. Changes in ASM and vascularity might affect lung function at school age.
Authors: Megan N Januska; David L Goldman; Wilmore Webley; W Gerald Teague; Robyn T Cohen; Supinda Bunyavanich; Alfin G Vicencio Journal: Pediatr Pulmonol Date: 2019-11-15
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Authors: Atul Gupta; Isabelle Pouliquen; Daren Austin; Robert G Price; Rodger Kempsford; Jonathan Steinfeld; Eric S Bradford; Steven W Yancey Journal: Pediatr Pulmonol Date: 2019-09-09