Investigation of young children with severe recurrent wheeze: any clinical benefit?

Abstract

The management of young children with severe recurrent wheeze is difficult because symptoms are often refractory to conventional asthma therapy and other diagnoses must be excluded. The present authors aimed to evaluate the outcome of detailed, invasive investigations in such patients.Children aged between 3 months and 5 yrs with severe recurrent wheezing, who had been referred to a tertiary centre, underwent a protocol of investigations including a chest computed tomography scan, blood tests, nasal ciliary brushings, fibreoptic bronchoscopy, bronchoalveolar lavage (BAL), endobronchial biopsy and passage of an oesophageal pH probe.A total of 47 children (25 males) with a median age of 26 (range 5-58) months underwent investigation. Of these, 39% were atopic, two-thirds had evidence of gastro-oesophageal reflux and 37 out of 47 had an abnormal bronchoscopy. Findings included structural abnormalities (13 out of 37), excessive mucus (20 out of 37) and macroscopic inflammation (10 out of 37). BAL revealed bacterial growth in 12 out of 44 (27%) patients. Good quality endobronchial biopsies were obtained from 36 out of 46 (78%) patients; of these, 44% had tissue eosinophila and 28% had a thickened reticular basement membrane.Additional investigations (including bronchoscopy) in young children with severe wheeze may help to identify positive diagnoses and provide information to support a clinical diagnosis of asthma. This hypothesis-generating work should form the basis of future interventional studies.

The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts

“…Most studies of preschool wheeze have been based on birth cohorts. A small number of studies have focused on severe preschool wheeze [9,30] and they have provided valuable insights into the underlying pathophysiology and natural history of preschool wheeze. In common with the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) [27] and SARP (Severe Asthma Research Program) [26,28] severe asthma cohorts, U-BIOPRED children with severe asthma were commonly atopic, had high healthcare utilisation and a high treatment burden.…”

Malacia, inflammation and bronchoalveolar lavage culture in children with persistent respiratory symptoms

“…This high prevalence of vascular compression may be due to the bias of the retrospective design of the study. SAGLANI et al [8] studied the clinical benefit of further investigations in preschool children with severe recurrent wheeze. Noisy breathing with or without wheezing periods was the main inclusion criterion.…”

Relationship between past airway pathology and current lung function in preschool wheezers

“…Subgroup analysis was performed on each of these threepaired categories. FeNO and lung function measurements were correlated with past RBM thickness and EG2+ cells (biopsy methods as previously reported) [8,12] in all wheezers and in the wheeze subgroups. By definition, the severe preschool wheezers were between 3 months and 5 yrs of age, and had at least three episodes of wheeze lasting .3 days in the previous 6 months [8].…”