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Airway and esophageal eosinophils in children with severe uncontrolled asthma

Jessica Erkman1, Allen Vaynblat2, Kristen Thomas3

  • 1Aerodigestive Center, Hassenfeld Children's Hospital, NYU Langone Health, New York.

Pediatric Pulmonology
|October 25, 2018
PubMed

Insights

Airway and esophageal eosinophils are common in children with severe uncontrolled asthma (SUA). Their presence correlates, suggesting a link between these conditions in pediatric asthma patients.

Area of Science:

  • Pediatric Pulmonology
  • Gastroenterology
  • Allergy and Immunology

Background:

  • Severe uncontrolled asthma (SUA) in children presents significant symptom burden and exacerbations.
  • Reflux and eosinophilic esophagitis are recognized comorbidities in SUA, linked to esophageal eosinophil presence.
  • The hypothesis posits frequent esophageal eosinophils and their correlation with airway eosinophils in pediatric SUA.

Purpose of the Study:

  • To investigate the prevalence of esophageal eosinophils in children with SUA.
  • To determine the correlation between airway and esophageal eosinophils in this patient group.
  • To explore the association between eosinophilic inflammation in the esophagus and airways of children with severe asthma.

Main Methods:

  • Retrospective analysis of a prospective database of children evaluated for SUA.
  • Inclusion of patients undergoing "triple endoscopy": laryngoscopy, bronchoscopy (bronchoalveolar lavage [BAL] and endobronchial biopsy [EBB]), and esophagogastroduodenoscopy with esophageal biopsy [EsB].
  • Exclusion of children with cystic fibrosis, primary ciliary dyskinesia, and aspiration-related lung disease.

Main Results:

  • Twenty-four children (ages 2-16 years) were analyzed.
  • Elevated eosinophils were detected in BAL (42%), endobronchial biopsies (67%), and esophageal biopsies (46%).
  • A significant correlation was found between airway eosinophils (BAL and/or EBB) and esophageal eosinophils (R=0.41, P=0.047).

Conclusions:

  • Airway and esophageal eosinophils are frequently observed in children diagnosed with severe uncontrolled asthma.
  • The study supports a link between eosinophilic inflammation in the airways and esophagus in pediatric SUA.
  • Findings suggest potential shared inflammatory pathways contributing to severe asthma in children.
Abstract

Keywords:
asthmaendobronchial biopsyeosinophils

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