Bronchoalveolar Cell Profiles in Children with Asthma, Infantile Wheeze, Chronic Cough, or Cystic Fibrosis

Abstract

Differential cell counts of bronchoalveolar lavage (BAL) have been reported in normal children but few data on cellular profiles in bronchial diseases in childhood are available. We determined the BAL cell profiles of 72 children divided into 5 groups: asthma (n = 14), chronic cough (n = 12), infantile wheeze (n = 26), cystic fibrosis (n = 10), and control (n = 10). The highest total cell, eosinophil, and neutrophil counts were found in children with cystic fibrosis. The cell profile of children with chronic cough was similar to that of control children. Asthma and infantile wheeze were characterized by a high median ratio of eosinophils (3%) and neutrophils (12%), respectively. In both diseases, epithelial shedding was suggested by an elevated epithelial cell count, 13.5 and 12%, respectively. Lymphocyte subset analysis showed a higher proportion of CD8 cells (58 versus 40%) and therefore a lower CD4/CD8 ratio (0.266 versus 0. 455) in children with asthma compared with infantile wheezers (p = 0. 02). Irrespective of the presence or absence of radiological abnormalities, a proportion of neutrophils > 10%, was found in one-third of the children with asthma and in half of the infantile wheezers, and was related to symptom severity. We suggest that neutrophil-mediated inflammation, with or without bacterial infection, may contribute to symptoms of asthma in childhood. Chronic cough, however, is not associated with the cell profiles suggestive of asthma and in isolation should not be treated with prophylactic antiasthma drugs.

Chronic cough in children: bronchoalveolar lavage findings

“…Thus the cough group is intermediate between normal control children and atopic asthmatics in terms of airway inflammation. 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].…”

Diagnosis of asthma in children under five

“…27 In a study using blind bronchoalveolar lavage at the time of routine paediatric surgery, there were no eosinophils in the lavage of children with VAW, quite different from atopic asthmatics. 28,29 One is forced to the conclusion that VAW is nothing to do with eosinophilic inflammation, and should not be treated the same way.…”

“…Relapse on stopping medications with second response to recommencing them 12 A. Bush Many children with chronic cough have only a non-specific problem, and have been shown on bronchoscopic and blind lavage studies to have no evidence of eosinophilic airway inflammation. 29,37 Follow up studies show that most will get better over 1-2 years. Others, however, will show evidence of deterioration of BHR over time, wheeze, and develop the picture of classical asthma.…”

Causal Relationship of Chronic Cough with Asthma and Upper Airway Problems in School Going Children Aged 8-12 Years

“…[15] In other studies, when airway profiles have been examined in children with isolated chronic cough, very few children with airway inflammation were found to be consistent with asthma. [16][17][18] Marguet and colleagues concluded that chronic cough is not associated with the cell profiles suggestive of asthma and in isolation should not be treated with prophylactic anti-asthma drugs. [18] The majority of children with cough do not have asthma.…”

“…[16][17][18] Marguet and colleagues concluded that chronic cough is not associated with the cell profiles suggestive of asthma and in isolation should not be treated with prophylactic anti-asthma drugs. [18] The majority of children with cough do not have asthma. [19,20] In contrast, some hospital based clinical studies of children presenting with chronic cough have found asthma as the most common cause.…”