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Bronchoalveolar lavage profiles in uncontrolled wheezy children compared by asthma predictive index
Dima Ezmigna1, Mark Brown2, Cori Daines3
1Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
Insights
Airway cytology did not differ between children with high or low asthma predictive index (API) scores. Persistent bacterial bronchitis may cause recurrent wheezing unresponsive to inhaled corticosteroids (ICS) in young children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- The asthma predictive index (API) identifies preschoolers at risk for developing asthma.
- Recurrent wheezing in young children unresponsive to inhaled corticosteroids (ICS) presents a clinical challenge.
- Airway inflammation patterns may differ based on API status in these children.
Purpose of the Study:
- To compare bronchoalveolar lavage (BAL) cell profiles in API-positive (API+) versus API-negative (API-) children with recurrent wheezing unresponsive to ICS.
- To investigate potential differences in airway cytology, specifically eosinophil and neutrophil dominance, between API+ and API- groups.
Main Methods:
- Retrospective analysis of BAL fluid from 43 children (3-36 months) receiving ICS.
- Assessment of BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages.
- Comparison of cell counts and distributions between API+ and API- groups.
Main Results:
- No significant differences in BAL cell differential counts (eosinophils, neutrophils, lymphocytes, macrophages) were observed between API+ and API- groups.
- Neutrophil percentages were elevated in both groups, correlating with positive bacterial cultures.
- Bacterial cultures were positive in a higher proportion of API+ children (60%) compared to API- children (41%), though not statistically significant.
Conclusions:
- Airway cytology profiles do not differ significantly between API+ and API- children with ICS-unresponsive recurrent wheezing.
- Neutrophil counts and granulocyte levels correlate with bacterial infections, suggesting a role in persistent symptoms.
- Persistent bacterial bronchitis appears to be a significant factor in ICS-unresponsive wheezing, irrespective of API status.
Objective:
The asthma predictive index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive (API+)/negative (API-) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API+ and neutrophils in API- groups respectively. The main objective of this study is to compare bronchoalveolar lavage (BAL) cell profiles in API+/API- children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS).
Design:
Retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API+, 12 API-). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages were analyzed. Cell counts presented as median (range).
Results:
Neutrophil percentages were increased in both groups (API- 16% [1%-76%]; API+ 42% [1%-95%]; p = NS). Cell percentages were similar for lymphocytes (API- 12% [1%-30%]; API+ 7% [1%-37%]), and macrophages (API- 67.5% [12%-97%]; API+ 41% [2%-94%]). Eosinophil percentages were low in both groups (API- 1% [1%-2%]; API+ 1% [1%-11%]). There was no difference in cellular distributions using absolute cell counts comparing API groups. Bacterial cultures were positive in 18 (60%) API+ and 5 (41%) API- patients (p = 0.10).
Conclusion:
Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Neutrophil percentages and total granulocyte count correlate with positive bacterial cultures independent of API status. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to ICS therapy regardless of API status with a trend to more positive cultures in API positive children.
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