Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Stevenson, E.C.; Turner, G. Grey; Heaney, Liam G.; Schock, Bettina; Taylor, Robert H.; Gallagher, T. M.; Ennis, Madeleine; Shields, Michael

doi:10.1111/j.1365-2222.1997.tb01254.x

Cited by 255 publications

(224 citation statements)

References 26 publications

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“…A different mechanism may be present in persistent wheezers, given their different prognoses. We (5,15,16) and others (17)(18)(19) have reported that children with persistent wheeze are more likely than transient early wheezers to have high serum IgE levels, eosinophilia, and skin test reactivity to local aeroallergens. Lowe and coworkers (20) showed that, regardless of the development of early respiratory symptoms, children with a strong family history of asthma who had become sensitized to local allergens had significantly lower specific airway conductance at age 3 yr compared with nonsensitized children.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Asthma and Wheezing in the First 6 Years of Life

Morgan

Stern

Sherrill

et al. 2005

Am J Respir Crit Care Med

603

417

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Rationale: The effect of early life wheezing on respiratory function and continued symptoms through adolescence has not been fully described. Using data from a population-based birth cohort in Tucson, Arizona, we previously described four phenotypes based on the occurrence of wheezing lower respiratory illnesses before age 3 yr and active wheeze at age 6 yr: never wheezers (n ϭ 425), transient early wheezers (n ϭ 164), persistent wheezers (n ϭ 113), and lateonset wheezers (n ϭ 124). Objective: We sought to determine the prognosis for these phenotypes, with reference to lung function and symptoms, through adolescence. Methods: Current wheeze was assessed by questionnaire, lung function was measured by conventional spirometry, and atopy was determined by skin prick tests. Results: The prevalence of atopy and wheeze by age 16 yr was similar for never and transient wheezers and for persistent and late-onset wheezers. Both transient early, and persistent wheezers had significantly lower FEF 25-75 (-259 ml/s, p Ͻ 0.001, and -260 ml/s, p ϭ 0.001, respectively), FEV 1 (-75 ml, p ϭ 0.02, and -87 ml, p ϭ 0.03, respectively), and FEV 1 :FVC ratio (-1.9%, p ϭ 0.002, and -2.5%, p ϭ 0.001, respectively) through age 16 yr compared with never wheezers. Late-onset wheezers had levels of lung function similar to those of never wheezers through age 16 yr. There was no significant change in lung function among subjects with any of the four phenotypes, relative to their peers, from age 6 to 16 yr. Conclusion: Patterns of wheezing prevalence and levels of lung function are established by age 6 yr and do not appear to change significantly by age 16 yr in children who start having asthmalike symptoms during the preschool years.

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Section: Discussionmentioning

confidence: 99%

Outcome of Asthma and Wheezing in the First 6 Years of Life

Morgan

Stern

Sherrill

et al. 2005

Am J Respir Crit Care Med

603

417

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“…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.…”

Section: What Causes Vaw?mentioning

confidence: 99%

Diagnosis of asthma in children under five

Bush

2007

Primary Care Respiratory Journal

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Summary: Cough and wheeze are common symptoms in childhood, but mostly do not signify a serious illness. On the basis of history and examination, such children should be allocated into one of five diagnostic categories. Very few need additional tests, although there are specific pointers in the initial evaluation which should actively be sought, and result in referral for investigation. In a community setting, isolated cough with no wheeze or breathlessness is most unlikely to be due to asthma. In pre-school children who cannot perform lung function tests, a therapeutic trial of asthma treatment may be indicated, but a three step protocol is mandatory, stopping therapy if there appears to be a response, and only restarting if symptoms recur. In older children, documentation of variable airflow obstruction before giving a diagnosis of asthma is important, to avoid overdiagnosis. Prophylactic therapy on a long term basis with inhaled steroids in preschool children does not reduce the likelihood of progression to asthma in midchildhood, and the results of treatment in terms of symptoms are disappointing.

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“…Children with chronic cough, without wheeze, due to cough variant asthma should exhibit airway inflammation similar to known atopic asthmatics, who have increased eosinophils and mast cells in their bronchoalveolar lavage fluid (BAL) [11] and increased concentrations of eosinophil cationic protein (ECP) and histamine in BAL [12]. The aim of the present study was to investigate the cell composition and inflammatory mediators within the airways of children with chronic cough and compare the results with the population of normal nonatopic children and atopic asthmatics, who had undergone lavage for both this and previous studies.…”

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confidence: 99%

Chronic cough in children: bronchoalveolar lavage findings

Fitch¹,

Brown²,

Schock³

et al. 2000

Eur Respir J

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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.

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Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Cited by 255 publications

References 26 publications

Outcome of Asthma and Wheezing in the First 6 Years of Life

Outcome of Asthma and Wheezing in the First 6 Years of Life

Diagnosis of asthma in children under five

Chronic cough in children: bronchoalveolar lavage findings

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