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Blood eosinophil counts rarely reflect airway eosinophilia in children with severe asthma

N Ullmann1, C J Bossley, L Fleming

  • 1Respiratory Paediatrics, Royal Brompton Hospital London and NHLI Imperial College London, London, UK.

Allergy
|January 26, 2013
PubMed

Insights

Peripheral blood tests are unreliable for diagnosing airway inflammation in children with severe therapy-resistant asthma (STRA). Bronchoscopy with bronchoalveolar lavage (BAL) is recommended for accurate assessment.

Area of Science:

  • Pediatric Pulmonology
  • Asthma Research
  • Inflammatory Diseases

Background:

  • Severe asthma phenotypes in adults may correlate with peripheral blood markers.
  • Investigating peripheral blood markers for severe therapy-resistant asthma (STRA) in children could avoid invasive procedures.
  • Limited evidence exists regarding peripheral blood markers in pediatric severe asthma.

Purpose of the Study:

  • To determine if peripheral blood inflammatory markers accurately reflect airway inflammation in children with STRA.
  • To assess the utility of blood tests versus invasive methods for diagnosing airway inflammation in pediatric severe asthma.

Main Methods:

  • Patients with STRA underwent peripheral blood tests, exhaled nitric oxide (FeNO) measurement, sputum induction, bronchoalveolar lavage (BAL), and endobronchial biopsy (EB).

Main Results:

  • Most patients (71.6%) had normal blood counts; only one showed combined eosinophilia and neutrophilia.
  • While 86% had normal blood eosinophils, 84% exhibited airway eosinophilia via BAL or EB.
  • Blood eosinophilia in STRA children correlated with airway eosinophilia, but normal blood eosinophils did not rule out airway inflammation.

Conclusions:

  • Peripheral blood counts are not reliable for characterizing airway inflammation in children with STRA, especially those on high-dose steroids.
  • Bronchoscopy with BAL is a more reliable method for assessing airway inflammation in this population.
  • Invasive procedures like BAL are necessary for accurate diagnosis in pediatric severe asthma.
Abstract

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