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Published on: March 24, 2014
Differential cytology of bronchoalveolar lavage fluid in asthmatic children
1Department of Pediatrics, Pediatric Respiratory Medicine and Cystic Fibrosis Clinic, Academic Hospital-Brussels Free University (VUB), Brussels, Belgium.
Insights
Asthma in children shows limited age-related changes in bronchoalveolar lavage fluid (BALF) cytology. Eosinophils differentiate allergic from nonallergic asthma, and neutrophil inflammation may be more significant than in adults.
Area of Science:
- Pediatric Pulmonology
- Respiratory Immunology
- Cellular Biology
Background:
- Asthma commonly initiates in childhood, yet data on pediatric inflammatory responses and age influences are limited.
- Understanding the specific inflammatory profiles in childhood asthma is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the bronchoalveolar lavage fluid (BALF) cytology in newly diagnosed wheezy children.
- To compare inflammatory markers between allergic and nonallergic pediatric asthma.
- To assess the influence of age on BALF cytology in children with asthma.
Main Methods:
- Bronchoalveolar lavage (BAL) was performed on 39 newly diagnosed wheezy children (21 allergic, 18 nonallergic) who had not received anti-inflammatory treatment.
- BAL fluid was collected in two fractions: BALF 1 for microbiology and cytology, BALF 2 for cytology.
- Cellular analysis included differential cytology, focusing on epithelial cells, neutrophils, and eosinophils.
Main Results:
- Fluid recovery during BAL inversely correlated with age, particularly for BALF 2.
- Children under 2 years exhibited higher levels of ciliated columnar and goblet cells.
- Eosinophils were significantly elevated in allergic children compared to nonallergic.
- Neutrophil counts were higher in children with positive microbiology and in non-infected children compared to adult asthma data.
Conclusions:
- BALF cytology in children with asthma shows limited age dependency.
- Differential cytology, especially eosinophil counts, aids in distinguishing allergic from nonallergic asthma.
- Neutrophil-driven inflammation appears more prominent in pediatric asthma than in adults, suggesting a distinct inflammatory pathway.
Abstract:
Although asthma usually begins in childhood, limited information is available as to the inflammatory reaction of asthmatic children compared to adults and the influence of age. We investigated the cytology of bronchoalveolar lavage fluid (BALF) in 39 newly diagnosed wheezy children (minimum of 3 wheezing episodes during last 6 months): 21 allergic and 18 nonallergic subjects. None had received antiinflammatory treatment. Bronchoalveolar lavage (BAL) was performed, instilling 0.5 ml.kg(-1) body weight of warmed saline in 4 successive fractions. The first 2 aliquots (BALF 1) were pooled for microbiology and cytology, and the last 2 (BALF 2) for cytology only. Recovery correlated inversely with age, the most significant being for BALF 2 (r = -0.52, P = 0.001). Children under 2 years of age had larger amounts of ciliated columnar and goblet cells (P = 0.0074). Other cell types did not show age dependency. Differential cytology was characterized by a high number of creola bodies, bronchial epithelial cells (M = 68 x 10(3).ml(-1), R = 5-349), and neutrophils (M = 92 x 10(3).ml(-1), R = 0-1,257). Eosinophils were the only cells distinguishing allergic from nonallergic subjects (P = 0.003). The 16 children with positive microbiology had more neutrophils than the noninfected (P = 0.008), the latter still having more neutrophils than found in adults. These data suggest a limited age dependency in BALF cytology. Differential cytology in BALF might be helpful in differentiating asthma in children. Neutrophil inflammation might be more important than in adults.
