title: Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children.
abstract: BACKGROUND
  Asthma phenotypes are well described among children. However, there are few studies comparing airway inflammation in different clinical presentations of pediatric asthma. We tested the hypothesis that nonatopic asthma is associated with a predominant noneosinophilic inflammation in the airways, as assessed by induced sputum. The objective of this study was to evaluate the cytological characteristics of induced sputum (IS) in atopic (AA), nonatopic asthmatics (NAA) and nonatopic nonasthmatic children (NANA).
  
  
  METHODS
  Of 90 selected children, 77 met eligibility criteria for performing IS and were classified as: AA, n = 28, NAA, n = 29 and NANA, n = 19. Subjects answered to a set of ISAAC-based questions and were skin-tested for common aeroallergens. A defined series of exclusion criteria was applied.
  
  
  RESULTS
  Induced sputum was obtained from 54 (70.1%) subjects (21 AA, 20 NAA and 13 NANA). Demographic data and mean FEV(1) were similar in the three groups. The proportion of eosinophils [median, inter quartile range (IQR)] was significantly higher in the sputum of AA [(6.0.)12)] compared with NAAs [0 (2)] and NANAs [0 (1)], P < 0.001. The proportion of children with sputum eosinophilia (eos > 3%) was also significantly higher in AA (71.4%) when compared with NAA (28.6%); none of the NANA had sputum eosinophilia. Nonatopic asthmatic children had significantly higher proportions and absolute number of neutrophils than AA and controls.
  
  
  CONCLUSIONS
  The results suggest that nonatopic children present IS with a cell pattern that is predominantly neutrophilic while eosinophilia is the hallmark of airway inflammation in the majority of atopic wheezing children not treated with inhaled steroids.
authors.affiliation: Pediatric Respirology Unit, Department of Pediatrics, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: A C
authors.initials: AC
authors.lastname: Drews
authors.forename: M M M
authors.initials: MM
authors.lastname: Pizzichini
authors.forename: E
authors.initials: E
authors.lastname: Pizzichini
authors.forename: M U
authors.initials: MU
authors.lastname: Pereira
authors.forename: P M
authors.initials: PM
authors.lastname: Pitrez
authors.forename: M H
authors.initials: MH
authors.lastname: Jones
authors.forename: P D
authors.initials: PD
authors.lastname: Sly
authors.forename: R T
authors.initials: RT
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000276:immunology* / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology / Q000503:physiopathology; D007249:Inflammation / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D009504:Neutrophils / Q000166:cytology / Q000276:immunology*; D013183:Sputum / Q000166:cytology / Q000276:immunology*