title: Epithelial damage and angiogenesis in the airways of children with asthma.
abstract: BACKGROUND
  Airway remodeling and inflammation are characteristic features of adult asthma that are still poorly investigated in childhood asthma.
  
  
  OBJECTIVE
  To examine epithelial and vascular changes as well as the inflammatory response in airways of children with asthma.
  
  
  METHODS
  We analyzed bronchial biopsies obtained from 44 children undergoing bronchoscopy for appropriate clinical indications other than asthma: 17 with mild/moderate asthma (aged 2-15 yr), 12 with atopy without asthma (1-11 yr), and 15 control children without atopy or asthma (1-14 yr). By histochemistry and immunohistochemistry, we quantified epithelial loss, basement membrane thickness, number of vessels, and inflammatory cells in subepithelium.
  
  
  RESULTS
  Epithelial loss and basement membrane thickness were increased in children with asthma compared with control subjects (p = 0.005 and p = 0.0002, respectively) and atopic children (p = 0.002 and p = 0.005, respectively). The number of vessels and eosinophils was increased not only in asthmatic children (p = 0.03 and p = 0.0002, respectively) but also in atopic children without asthma (p = 0.03 and p = 0.008, respectively) compared with control subjects. When we stratified the analysis according to age, we observed that children with asthma younger than 6 yr had increased epithelial loss, basement membrane thickening, and eosinophilia compared with control subjects of the same age.
  
  
  CONCLUSIONS
  Epithelial damage and basement membrane thickening, which are pathologic features characteristic of adult asthma, are present even in childhood asthma. Other changes, such as airway eosinophilia and angiogenesis, were also observed in atopic children without asthma. These observations suggest that pathologic changes occur early in the natural history of asthma and emphasize the concept that some of these lesions may characterize atopy even in the absence of asthmatic symptoms.
authors.affiliation: Divisione di Pneumologia, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari Università degli Studi di Padova, via Giustiniani 3, Padova, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Barbato
authors.forename: Graziella
authors.initials: G
authors.lastname: Turato
authors.forename: Simonetta
authors.initials: S
authors.lastname: Baraldo
authors.forename: Erica
authors.initials: E
authors.lastname: Bazzan
authors.forename: Fiorella
authors.initials: F
authors.lastname: Calabrese
authors.forename: Cristina
authors.initials: C
authors.lastname: Panizzolo
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Zanin
authors.forename: Renzo
authors.initials: R
authors.lastname: Zuin
authors.forename: Piero
authors.initials: P
authors.lastname: Maestrelli
authors.forename: Leonardo M
authors.initials: LM
authors.lastname: Fabbri
authors.forename: Marina
authors.initials: M
authors.lastname: Saetta
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000473:pathology* / Q000503:physiopathology*; D001485:Basement Membrane / Q000473:pathology; D001980:Bronchi / Q000473:pathology* / Q000503:physiopathology*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D008297:Male; D009389:Neovascularization, Pathologic