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Role of infection in the middle lobe syndrome in asthma
C Springer1, A Avital, N Noviski
1Institute of Pulmonology, Hadassah University Hospital, Jerusalem.
Insights
Longstanding lung collapse in children with asthma is often linked to bacterial infections, particularly Haemophilus influenzae and Streptococcus pneumoniae. This study highlights the importance of investigating bacterial causes in pediatric asthma patients with persistent pulmonary collapse.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Pediatric Asthma Research
Background:
- Asthma is a common chronic respiratory disease in children.
- Pulmonary collapse, specifically right middle lobe or lingular collapse, can occur in children with asthma and persist for extended periods.
- The underlying causes and associations of such prolonged collapse in pediatric asthma are not fully understood.
Purpose of the Study:
- To investigate the association between longstanding pulmonary collapse (right middle lobe or lingular) and bacterial infection in children with asthma.
- To analyze the characteristics of pediatric asthma patients experiencing pulmonary collapse.
Main Methods:
- A cohort of 21 children (aged 1.0-10.5 years) with asthma and pulmonary collapse were admitted for evaluation.
- Fiberoptic bronchoscopy under local anesthesia was performed on all participants.
- Bronchoalveolar lavage (BAL) was conducted, and differential cell counts and bacterial cultures were analyzed.
Main Results:
- Neutrophil predominance was observed in the BAL fluid of 12 patients (57%).
- Bacterial pathogens, primarily Haemophilus influenzae and Streptococcus pneumoniae, were cultured from 9 of these patients.
- No significant correlation was found between asthma severity or the duration of collapse and the presence of bacterial cultures.
Conclusions:
- Longstanding right middle lobe or lingular collapse in asthmatic children is frequently associated with bacterial infections.
- Bacterial pathogens like Haemophilus influenzae and Streptococcus pneumoniae are common in this patient group.
- Further investigation into bacterial etiologies is warranted for pediatric asthma patients presenting with persistent pulmonary collapse.
Abstract:
Twenty one children with asthma aged 1.0-10.5 years (mean (SD) 3.3 (2.5) years) were admitted to the hospital to evaluate pulmonary right middle lobe or lingular collapse lasting one to 12 months (mean (SD) 4.4 (3.8) months). Seven children had mild asthma and were treated with inhaled beta 2 agonists as needed. Nine had moderate asthma treated with either sodium cromoglycate or slow release theophylline. Five had severe asthma treated with inhaled steroids. Each child underwent fibreoptic bronchoscopy under local anaesthesia and a bronchoalveolar lavage. Differential cell counts of the lavage fluid revealed predominance of neutrophils in 12 patients (57%). In nine of these patients cultures grew pathogenic bacteria, mainly Haemophilus influenzae and Streptococcus pneumoniae. There was no correlation between the severity of asthma and a positive bacterial culture. There was also no correlation between the duration of the right middle lobe collapse and a positive culture. We conclude that longstanding right middle lobe collapse in asthmatic children is often associated with bacterial infection.