Persistent wheezing in very young children is associated with lower respiratory inflammation

• Published in: American journal of respiratory and critical care medicine Vol. 163; no. 6; pp. 1338 - 1343
• Main Authors: KRAWIEC, Marzena E, WESTCOTT, Jay Y, HONG WEI CHU, BALZAR, Silvana, TRUDEAU, John B, SCHWARTZ, L. B, WENZEL, Sally E
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.05.2001
• Subjects: Age Factors; Asthma - diagnosis; Asthma - immunology; Biological and medical sciences; Bronchoalveolar Lavage Fluid - chemistry; Bronchoalveolar Lavage Fluid - cytology; Bronchoalveolar Lavage Fluid - immunology; Bronchoscopy; Case-Control Studies; Chronic Disease; Chronic obstructive pulmonary disease, asthma; Dinoprostone - analysis; Disease Progression; Female; Humans; Hydroxyeicosatetraenoic Acids - analysis; Infant; Inflammation; Inflammation Mediators - chemistry; Inflammation Mediators - immunology; Leukocyte Count; Leukotriene B4 - analysis; Male; Medical sciences; Pneumology; Prostaglandin D2 - analysis; Respiratory Sounds - diagnosis; Respiratory Sounds - immunology; Risk Factors; Serine Endopeptidases - analysis; Tryptases; Human; Persistence; Respiratory tract; Symptomatology; Respiratory disease; Pathogenesis; Wheezing; Inflammation; Obstructive pulmonary disease; Child; Asthma
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.163.6.2005116

Despite advances in understanding the pathophysiology of asthma, morbidity and mortality in pediatrics continue to rise. Little is known about the initiation and chronicity of inflammation resulting in asthma in this young population. We evaluated 20 "wheezing" children (WC) (median age 14.9 mo) with a minimum of two episodes of wheezing or prolonged wheezing > or = 2 mo in a 6-mo period with bronchoscopy and bronchoalveolar lavage (BAL). Comparisons were made with six normal controls (NC) (median age 23.3 mo) undergoing general anesthesia for elective surgery. BAL fluid cell counts and differentials were determined. The eicosanoids, leukotriene (LT) B(4), LTE(4), prostaglandin (PG)E(2), and 15-hydroxyeicosatetraenoic acid (HETE) and the mast cell mediators, beta-tryptase and PGD(2), were evaluated by enzyme immunoassay (EIA). WC had significant elevations in total BAL cells/ml (p = 0.01), as well as, lymphocytes (LYMPH, p = 0.007), macrophages/monocytes (M&M, p = 0.02), polymorphonuclear cells (PMN, p = 0.02), epithelial cells (EPI, p = 0.03), and eosinophils (EOS, p = 0.04) compared with NC. Levels of PGE(2) (p = 0.0005), 15-HETE (p = 0.002), LTE(4) (p = 0.04), and LTB(4) (p = 0.05) were also increased in WC compared with NC, whereas PGD(2) and beta-tryptase were not. This study confirms that inflammation is present in the airways of very young WC and may differ from patterns seen in adults with asthma.