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Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Heterogeneity of lower airway inflammation in children with severe-persistent asthma
Caitlin E O'Brien1, Kalliope Tsirilakis2, Maria Teresa Santiago2
1Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
Insights
This study analyzed airway inflammation in children with severe-persistent asthma, finding neutrophilic inflammation most common. Further research is needed to link inflammation patterns to causes and guide personalized asthma treatments.
Area of Science:
- Pediatric Pulmonology
- Asthma Pathophysiology
- Immunology
Background:
- Severe-persistent asthma in children presents treatment challenges.
- Inflammatory profiles may guide personalized asthma management strategies.
- This study investigates airway inflammation patterns in pediatric severe asthma.
Purpose of the Study:
- To characterize the inflammatory profile in bronchoalveolar lavage (BAL) fluid from children with severe-persistent asthma.
- To compare these inflammatory profiles with serum IgE levels.
- To identify potential patterns for improved asthma treatment.
Main Methods:
- Retrospective analysis of BAL fluid from 32 children with severe-persistent asthma (Severe Asthma Research Program criteria).
- Classification of inflammatory patterns: neutrophilic, eosinophilic, mixed, or pauci-granulocytic.
- Measurement of serum total IgE and correlation with BAL inflammatory markers.
Main Results:
- Neutrophilic inflammation was the most prevalent pattern (37.5%), followed by eosinophilic (28.1%), mixed (21.9%), and pauci-granulocytic (11.1%).
- A significant correlation was found between serum IgE levels and BAL eosinophil percentages (P = 0.04).
- An eosinophilic BAL pattern showed an odds ratio of 4.67 for elevated serum IgE (P = 0.12).
Conclusions:
- This study highlights significant heterogeneity in lower airway inflammation in children with severe-persistent asthma.
- Results indicate a higher prevalence of neutrophilic inflammation compared to some previous pediatric studies.
- Further research is essential to determine if specific inflammatory patterns correlate with distinct etiologies and warrant individualized therapeutic approaches.
Rationale:
The treatment of children with severe-persistent asthma remains problematic. Recent studies suggest that stratification of this cohort by inflammatory type may be useful in designing effective treatment strategies. In this study, we examined the inflammatory profile in bronchoalveolar lavage fluid from children with severe-persistent asthma and compared this profile with serum IgE levels.
Methods:
The inflammatory profile in the bronchoalveolar fluid from 32 children who met criteria for severe-persistent asthma as defined by the Severe Asthma Research Program (SARP) were analyzed retrospectively. Inflammatory patterns were classified as neutrophilic, eosinophilic, mixed, or pauci-granulocytic. Serum total IgE was measured prior to bronchoscopy and determined by ELISA at each hospital's lab by standard procedures.
Results:
The most common pattern of inflammation in this cohort was neutrophilic (37.5%) followed by eosinophilic (28.1%), mixed (21.9%), and pauci-granulocytic (11.1%). The odds ratio of an eosinophilic BAL pattern for patients with an elevated serum IgE was 4.67 (CI 0.78-28, P = 0.12). A correlation between serum IgE levels and BAL eosinophil percentages was present (P = 0.04).
Conclusions:
To our knowledge, ours is one of few studies to systematically investigate the pattern of lower airway inflammation in children with severe-persistent asthma. Our results differ from a recent investigation in children, showing more heterogeneity and a greater proportion of neutrophilic inflammation. Further investigation is required to determine whether specific inflammatory patterns are associated with specific etiologies, and whether individualized therapy is warranted.
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