title: Persistent wheezing in very young children is associated with lower respiratory inflammation.
abstract: 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.
authors.affiliation: Department of Pediatrics and Medicine, National Jewish Medical and Research Center, Denver, Colorado, USA. mekrawiec@facstaff.wisc.edu
authors.forename: M E
authors.initials: ME
authors.lastname: Krawiec
authors.forename: J Y
authors.initials: JY
authors.lastname: Westcott
authors.forename: H W
authors.initials: HW
authors.lastname: Chu
authors.forename: S
authors.initials: S
authors.lastname: Balzar
authors.forename: J B
authors.initials: JB
authors.lastname: Trudeau
authors.forename: L B
authors.initials: LB
authors.lastname: Schwartz
authors.forename: S E
authors.initials: SE
authors.lastname: Wenzel
mesh_terms: D000367:Age Factors; D001249:Asthma / Q000175:diagnosis* / Q000276:immunology*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000166:cytology / Q000276:immunology*; D001999:Bronchoscopy; D016022:Case-Control Studies; D002908:Chronic Disease; D015232:Dinoprostone / Q000032:analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D006893:Hydroxyeicosatetraenoic Acids / Q000032:analysis; D007223:Infant; D007249:Inflammation; D018836:Inflammation Mediators / Q000737:chemistry* / Q000276:immunology*; D007958:Leukocyte Count; D007975:Leukotriene B4 / Q000032:analysis; D008297:Male; D015230:Prostaglandin D2 / Q000032:analysis; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000276:immunology*; D012307:Risk Factors; D012697:Serine Endopeptidases / Q000032:analysis; D053802:Tryptases
chemical_list: D006893:Hydroxyeicosatetraenoic Acids; D018836:Inflammation Mediators; D007975:Leukotriene B4; D012697:Serine Endopeptidases; D053802:Tryptases; D015232:Dinoprostone; D015230:Prostaglandin D2