Increased airway smooth muscle in preschool wheezers who have asthma at school age.
BACKGROUND
Increased airway smooth muscle (ASM) is a feature of established asthma in schoolchildren, but nothing is known about ASM in preschool wheezers.


OBJECTIVE
We sought to determine endobronchial biopsy specimen ASM area fraction in preschool wheezers and its association with asthma at school age.


METHODS
ASM area, reticular basement membrane thickness, and mucosal eosinophil and ASM mast cell values were quantified in endobronchial biopsy specimens previously obtained from preschool children undergoing clinically indicated bronchoscopy: severe recurrent wheezers (n=47; median age, 26 months) and nonwheezing control subjects (n=21; median age, 15 months). Children were followed up, and asthma status was established at age 6 to 11 years. Preschool airway pathology was examined in relation to asthma at school age.


RESULTS
Forty-two (62%) of 68 children had 1 or more evaluable biopsy specimens for ASM. At school age, 51 of 68 children were followed up, and 15 (40%) of 37 preschool wheezers had asthma. Children who had asthma and an evaluable biopsy specimen had increased preschool ASM area fraction (n=8; median age, 8.2 years [range, 6-10.4 years]; median ASM, 0.12 [range, 0.08-0.16]) compared with that seen in children without asthma (n=24; median age, 7.3 years [range, 5.9-11 years]; median ASM, 0.07 [range, 0.02-0.23]; P=.007). However, preschool reticular basement membrane thickness and mucosal eosinophil or ASM mast cell values were not different between those who did or did not have asthma at school age.


CONCLUSIONS
Increased preschool ASM is associated with those children who have asthma at school age. Thus a focus on early changes in ASM might be important in understanding the subsequent development of childhood asthma.
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Ruth
R
O'Reilly
Nicola
N
Ullmann
Samantha
S
Irving
Cara J
CJ
Bossley
Samatha
S
Sonnappa
Jie
J
Zhu
Timothy
T
Oates
Winston
W
Banya
Peter K
PK
Jeffery
Andrew
A
Bush
Sejal
S
Saglani
D001249:Asthma / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology*; D001706:Biopsy; D001980:Bronchi / Q000276:immunology / Q000473:pathology*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D004804:Eosinophils / Q000276:immunology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008407:Mast Cells / Q000276:immunology / Q000473:pathology; D009130:Muscle, Smooth / Q000276:immunology / Q000473:pathology*; D012129:Respiratory Function Tests; D020545:Respiratory Mucosa / Q000276:immunology / Q000473:pathology; D012135:Respiratory Sounds / Q000276:immunology / Q000503:physiopathology*