title: Malacia, inflammation and bronchoalveolar lavage culture in children with persistent respiratory symptoms.
abstract: In children with persistent respiratory symptoms despite regular anti-asthma inhalation treatment, diagnostic investigations to exclude underlying disease are warranted. 124 children were prospectively enrolled, and 24-h oesophageal pH measurement and fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) were performed. BAL fluid (BALF) was processed for neutrophil counting and bacterial culture. Inflammation of the respiratory mucosa was assessed. A structural abnormality of the central airways was found in 47% of subjects (40% females). In 19% of subjects, neither anatomical anomalies nor inflamed respiratory mucosa were observed, whereas in 64%, definite macroscopic mucosal inflammation was observed. Inflammation of the respiratory mucosa was associated with a significantly higher percentage of neutrophils in the BALF: median (interquartile range) 48 (14-82)% compared with 7 (0-16)% (p<0.025). A positive BALF culture was found in 62% of the infants with mucosal inflammation compared with 25% in the group without inflammation (p<0.016). 56% of the BALF samples were positive for bacterial culture. In children with persistent respiratory symptoms, nearly half have anatomical anomalies of the central airways. In 62% of the children with mucosal inflammation, a positive BAL culture and a significantly higher percentage of BALF neutrophils were detected.
authors.affiliation: Dept of Pediatric Pulmonology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. frans.debaets@ugent.be
authors.forename: F
authors.initials: F
authors.lastname: De Baets
authors.forename: I
authors.initials: I
authors.lastname: De Schutter
authors.forename: C
authors.initials: C
authors.lastname: Aarts
authors.forename: F
authors.initials: F
authors.lastname: Haerynck
authors.forename: S
authors.initials: S
authors.lastname: Van Daele
authors.forename: E
authors.initials: E
authors.lastname: De Wachter
authors.forename: A
authors.initials: A
authors.lastname: Malfroot
authors.forename: P
authors.initials: P
authors.lastname: Schelstraete
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology; D001999:Bronchoscopy; D003371:Cough / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D008297:Male; D009504:Neutrophils / Q000166:cytology; D011014:Pneumonia / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D020545:Respiratory Mucosa / Q000276:immunology / Q000473:pathology; D012135:Respiratory Sounds / Q000276:immunology; D055090:Tracheomalacia / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology