Bronchial Epithelial Inflammation in Children with Chronic Cough after Early Lower Respiratory Tract Illness

Heino, Matti T. J.; Juntunen‐Backman, Kaisu; Leijala, M.; Rapola, J; Laitinen, Lauri A.

doi:10.1164/ajrccm/141.2.428

Cited by 46 publications

(23 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The median epithelial cell count in sputum from asthmatic children was several fold higher (14%) than from normal subjects (1.5%). Although this has been well-documented in adults with asthma [15,16], and some epithelial damage has been reported in children with chronic cough [17], the marked epithelial shedding reported in this study is a novel finding in childhood asthma. This study clearly demonstrates the degree of epithelial damage which can occur in children with asthma, even when this is controlled.…”

Section: Discussionsupporting

confidence: 46%

Persistence of sputum eosinophilia in children with controlled asthma when compared with healthy children

Cai¹,

Carty²,

Rl³

et al. 1998

Eur Respir J

121

View full text Add to dashboard Cite

We aimed to describe induced sputum cell counts in healthy nonasthmatic children, and to compare these to children with controlled and uncontrolled asthma. Following clinical assessment and spirometry, ultrasonically nebulized hypertonic saline was used to induce sputum from children with asthma (n=50) and without asthma (n=72). Sputum was dispersed and cell counts performed to yield total and differential cell counts. Specific stains were used for eosinophil and mast cell counts. All of the children with asthma were receiving inhaled and/or oral corticosteroids. Current asthma control was assessed in terms of symptoms and lung function. Children were classified as controlled on inhaled corticosteroids (no current symptoms, normal lung function n=15), current symptomatic asthma (n=16) and asthma exacerbation (n=11). It was found that eosinophils comprised a median 0.3% (interquartile range (IQR): 0, 1.05) of cells in sputum from healthy children. Sputum eosinophils (4.3% (IQR: 15, 14.1) p=0.0005) and epithelial cells (14% (IQR: 6, 19.4) p=0.0005) were significantly higher in children with asthma than in nonasthmatic children. Children whose asthma was controlled, as well as those with symptoms, had more sputum eosinophils and epithelial cells than the nonasthmatics. Mast cells were found in the sputum of only four of the 42 children with asthma. This study demonstrates that eosinophilic airway inflammation and epithelial damage can occur in children with asthma. Airway inflammation persists even in those children who are receiving inhaled corticosteroids, have normal lung function and good symptomatic control of their disease.

show abstract

Section: Discussionsupporting

confidence: 46%

Persistence of sputum eosinophilia in children with controlled asthma when compared with healthy children

Cai¹,

Carty²,

Rl³

et al. 1998

Eur Respir J

121

View full text Add to dashboard Cite

show abstract

“…MARGUET et al [15] found no difference between the cough and control groups; thus the present results are not entirely consistent with their findings. Biopsies from seven children with unexplained cough revealed mucosal oedema and an inflammatory cell infiltrate consisting mainly of Iymphocytes [16]. In three out of 23 children BAL percentage eosinophils were elevated.…”

Section: Discussionmentioning

confidence: 92%

Chronic cough in children: bronchoalveolar lavage findings

Fitch¹,

Brown²,

Schock³

et al. 2000

Eur Respir J

View full text Add to dashboard Cite

Isolated chronic cough in childhood is a common complaint. Although the symptom cough is included in the definition of childhood asthma, there is debate as to whether the majority of these children have asthma. The authors studied children with isolated chronic cough looking for evidence of airway inflammation typical of asthma, with increased numbers of airway eosinophils as assessed from bronchoalveolar lavage (BAL).The investigations were carried out on 23 children (median age: 6.7 yrs; (range: 1.7±12.75 yrs), attending the Royal Belfast Hospital for Sick Children for elective surgery, who also had a chronic unexplained cough. Written informed consent was obtained from the parent(s) and a nonbronchoscopic BAL was performed. BAL samples were analysed for total and differential white cell counts and also for the inflammatory mediators, eosinophil cationic protein (ECP) and histamine. Results were compared with a group of normal nonatopic children and also a group of atopic asthmatic children, who had been recruited for other studies on airway inflammation.There was a small but statistically significant increase in BAL percentage eosinophils in the children with chronic cough compared with nonasthmatic controls (0.28% versus 0.10%, p=0.03). However, the children with cough had lower percentage eosinophils than the atopic asthmatic controls (0.28% versus 0.66%, p=0.01). Three out of 23 children with chronic cough had BAL eosinophils greater than the normal upper 95% reference interval in BAL. There was a small but statistically significant increase in percentage neutrophils in the children with cough compared with the nonasthmatic controls (5.85% versus 3.21%, p=0.03). Four out of the 23 children had BAL neutrophils greater than the normal upper 95% reference interval in BAL.The authors conclude that only a minority of children with chronic unexplained cough have asthmatic-type airway inflammation. It is speculated that the increased percentage neutrophils in bronchoalveolar lavage from children with cough could relate to underlying persistent airways infection.

show abstract

“…Acute viral infection induces lower airway inflammation [56] which may persist long after the infection has resolved [57]. Inflammatory changes including damaged bronchial epithelial, basement membrane thickening and a chronic inflammatory (mainly lymphocytic) infiltrate have been demonstrated in bronchial biopsies from patients with chronic cough [58].…”

Section: Inflammation Cough Reflex Sensitisation and Airway Sensory mentioning

confidence: 99%

Are there clinical features of a sensitized cough reflex?

McGarvey

McKeagney²,

Polley

et al. 2009

Pulmonary Pharmacology & Therapeutics

View full text Add to dashboard Cite

Key words: sensory hyperresponsiveness, hyperreactivity, cough reflex, receptor AbstractCough reflex hypersensitization is a key feature in patients with troublesome cough. The clinical consequence of this hypersensitive state is typified by bouts of coughing often triggered by low threshold stimuli encountered by the patient during normal daily activities including exposure to aerosols, scents and odours, a change in air temperature and when talking or laughing. These features are often perceived by cough patients to be the most disruptive aspect of their condition and undoubtedly contribute to impaired quality of life.Patients with troublesome cough may describe a range of additional symptoms and sensations including an 'urge to cough' or the feeling of an 'itch' at the back of the throat, or a choking sensation and occasionally chest pain or breathlessness. It is uncertain if these features arise due to the processes responsible for cough reflex sensitisation or as a direct consequence of the underlying cough aetiology. In an attempt to understand the clinical features of a sensitized cough reflex, the spectrum of symptoms typically described by cough patients will be reviewed and possible underlying mechanisms considered. Since an intact cough reflex is crucial to airway protection, anti-tussive treatment that attenuates the hypersensitive cough state rather than abolishing the cough reflex completely would be preferable. Identifying such agents remains a clinical, scientific and pharmacological challenge.

show abstract

Bronchial Epithelial Inflammation in Children with Chronic Cough after Early Lower Respiratory Tract Illness

Cited by 46 publications

References 5 publications

Persistence of sputum eosinophilia in children with controlled asthma when compared with healthy children

Persistence of sputum eosinophilia in children with controlled asthma when compared with healthy children

Chronic cough in children: bronchoalveolar lavage findings

Are there clinical features of a sensitized cough reflex?

Contact Info

Product

Resources

About