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Bronchoalveolar cells in children < 3 years old with severe recurrent wheezing
Muriel Le Bourgeois1, Maria Goncalves, Laurence Le Clainche
1Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France. muriel.lebourgeois@nck.ap-hop-paris.fr
Insights
Infants with severe recurrent wheezing show higher airway neutrophils, indicating inflammation. This neutrophil-driven process, not eosinophils, characterizes early childhood wheezing.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Respiratory Medicine
Background:
- Severe recurrent wheezing in infants is a common clinical problem.
- Ongoing airway inflammation is suspected even when children are not acutely ill.
- Understanding the cellular profile of bronchoalveolar lavage (BAL) can elucidate underlying inflammatory mechanisms.
Purpose of the Study:
- To determine the bronchoalveolar lavage (BAL) cell profile in infants with severe recurrent wheezing.
- To identify specific inflammatory markers associated with this condition in young children.
- To differentiate the inflammatory profile from non-wheezing pulmonary diseases.
Main Methods:
- Retrospective analysis of BAL cell profiles from 83 children (4-32 months) with severe recurrent wheezing.
- Comparison with 17 control children (6-36 months) with non-wheezing pulmonary diseases.
- Fiberoptic bronchoscopy performed on children unresponsive to inhaled steroids; controls had no inflammation or atopy.
Main Results:
- Children with wheezing had significantly higher BAL cell counts and neutrophil percentages/counts compared to controls.
- Increased neutrophils were not linked to infection, age, sex, or atopy.
- Eosinophil levels were similar in wheezing children and controls, unlike in asthmatic adults.
Conclusions:
- Neutrophil-mediated inflammation is a key characteristic of severe recurrent wheezing in children under 3 years old.
- This contrasts with adult asthma, where eosinophils are often elevated.
- The findings suggest a distinct inflammatory pathway in early childhood wheezing.
Study Objective:
To determine the cell profile of BAL from infants with severe recurrent wheezing who were not acutely ill at the time of investigation, suggesting an ongoing inflammation.
Design And Patients:
In a retrospective study, we determined BAL cell profiles for 83 children with wheezing aged 4 to 32 months (mean +/- SD, 11.3 +/- 5.5 months). Fiberoptic bronchoscopy was performed in children with severe recurrent wheezy bronchitis unresponsive to inhaled steroids. These children were compared with 17 children aged 6 to 36 months (mean, 15.1 +/- 7.5 months) with various nonwheezing pulmonary diseases. Children were included as control subjects if they had no endobronchial inflammation and no atopy.
Results:
The BAL cell profile of young children with wheezing typically includes a significantly higher cell count (mean, 644.4 +/- 956.8 x 10(3)/mL vs 313 +/- 203.2 x 10(3)/mL, p = 0.008), a significantly higher percentage of neutrophils (mean, 9 +/- 12.1% vs 2.1 +/- 2.2%, p = 0.003), and a higher neutrophil count (mean, 43.2 +/- 81.6 x 10(3)/mL vs 7.9 +/- 11.8 x 10(3)/mL, p = 0.003), as compared with control subjects. The larger number of neutrophils in children with wheezing was not correlated with bacterial or viral infection, or with age, sex, or atopic status. In contrast to the situation in asthmatic adults, eosinophil levels were not higher in children with wheezing than in control subjects (mean, 0.09 +/- 0.27% vs 0.08 +/- 0.25%).
Conclusion:
Neutrophil-mediated inflammation in the airways appears to better characterize severe recurrent wheezing in children < 3 years old.