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Persistent wheezing in very young children is associated with lower respiratory inflammation
M E Krawiec1, J Y Westcott, H W Chu
1Department of Pediatrics and Medicine, National Jewish Medical and Research Center, Denver, Colorado, USA. mekrawiec@facstaff.wisc.edu
Insights
Pediatric wheezing children show airway inflammation with elevated cells and specific eicosanoids. This suggests early asthma may involve distinct inflammatory pathways compared to adults.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Respiratory Medicine
Background:
- Pediatric asthma morbidity and mortality are increasing.
- The early inflammatory processes in pediatric asthma remain poorly understood.
- Understanding childhood wheezing is crucial for early intervention.
Purpose of the Study:
- To investigate airway inflammation in young children experiencing wheezing.
- To compare inflammatory markers in wheezing children with healthy controls.
- To identify specific inflammatory mediators involved in pediatric wheezing.
Main Methods:
- Bronchoscopy and bronchoalveolar lavage (BAL) were performed on 20 wheezing children (WC) and 6 normal controls (NC).
- BAL fluid cell counts and differentials were analyzed.
- Levels of eicosanoids (LTB(4), LTE(4), PGE(2), 15-HETE) and mast cell mediators (beta-tryptase, PGD(2)) were measured using enzyme immunoassay (EIA).
Main Results:
- Wheezing children exhibited significantly higher total BAL cells, including lymphocytes, macrophages/monocytes, polymorphonuclear cells, epithelial cells, and eosinophils compared to controls.
- Elevated levels of PGE(2), 15-HETE, LTE(4), and LTB(4) were observed in wheezing children.
- No significant differences in PGD(2) or beta-tryptase levels were found between groups.
Conclusions:
- Inflammation is confirmed in the airways of very young wheezing children.
- The inflammatory profile in pediatric wheezing may differ from adult asthma patterns.
- These findings highlight the need for further research into pediatric asthma pathogenesis.
Abstract:
Despite advances in understanding the pathophysiology of asthma, morbidity and mortality in pediatrics continue to rise. Little is known about the initiation and chronicity of inflammation resulting in asthma in this young population. We evaluated 20 "wheezing" children (WC) (median age 14.9 mo) with a minimum of two episodes of wheezing or prolonged wheezing > or = 2 mo in a 6-mo period with bronchoscopy and bronchoalveolar lavage (BAL). Comparisons were made with six normal controls (NC) (median age 23.3 mo) undergoing general anesthesia for elective surgery. BAL fluid cell counts and differentials were determined. The eicosanoids, leukotriene (LT) B(4), LTE(4), prostaglandin (PG)E(2), and 15-hydroxyeicosatetraenoic acid (HETE) and the mast cell mediators, beta-tryptase and PGD(2), were evaluated by enzyme immunoassay (EIA). WC had significant elevations in total BAL cells/ml (p = 0.01), as well as, lymphocytes (LYMPH, p = 0.007), macrophages/monocytes (M&M, p = 0.02), polymorphonuclear cells (PMN, p = 0.02), epithelial cells (EPI, p = 0.03), and eosinophils (EOS, p = 0.04) compared with NC. Levels of PGE(2) (p = 0.0005), 15-HETE (p = 0.002), LTE(4) (p = 0.04), and LTB(4) (p = 0.05) were also increased in WC compared with NC, whereas PGD(2) and beta-tryptase were not. This study confirms that inflammation is present in the airways of very young WC and may differ from patterns seen in adults with asthma.