title: Airway Remodeling in Preschool Children with Severe Recurrent Wheeze.
abstract: BACKGROUND
  Airway wall structure in preschoolers with severe recurrent wheeze is poorly described.
  
  
  OBJECTIVE
  To describe airway wall structure and inflammation in preschoolers with severe recurrent wheeze.
  
  
  METHODS
  Flexible bronchoscopy was performed in two groups of preschoolers with severe recurrent wheeze: group 1, less than or equal to 36 months (n = 20); group 2, 36-59 months (n = 29). We assessed airway inflammation, reticular basement membrane (RBM) thickness, airway smooth muscle (ASM), mucus gland area, vascularity, and epithelial integrity. Comparisons were then made with biopsies from 21 previously described schoolchildren with severe asthma (group 3, 5-11.2 yr).
  
  
  RESULTS
  RBM thickness was lower in group 1 than in group 2 (3.3 vs. 3.9 μm; P = 0.02), was correlated with age (P < 0.01; ρ = 0.62), and was higher in schoolchildren than in preschoolers (6.8 vs. 3.8 μm; P < 0.01). ASM area was lower in preschoolers than in schoolchildren (9.8% vs. 16.5%; P < 0.01). Vascularity was higher in group 1 than in group 2 (P = 0.02) and group 3 (P < 0.05). Mucus gland area was higher in preschoolers than in schoolchildren (16.4% vs. 4.6%; P < 0.01). Inflammatory cell counts in biopsies were not correlated with airway wall structure. ASM area was higher in preschoolers with atopy than without atopy (13.1% vs. 7.7%; P = 0.01). Airway morphometrics and inflammation were similar in viral and multiple-trigger wheezers.
  
  
  CONCLUSIONS
  In preschoolers with severe recurrent wheeze, markers of remodeling and inflammation are unrelated, and atopy is associated with ASM. In the absence of control subjects, we cannot determine whether differences observed in RBM thickness and vascularity result from disease or normal age-related development.
authors.affiliation: 1 AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France.|2 Université Paris Descartes, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lezmi
authors.affiliation: 3 Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Lille, France.|4 Université Lille Nord de France, Lille, France.|5 Centre National de la Recherche Scientifique, UMR 8204, Lille, France.|6 Institut National de la Santé et de la Recherche Médicale, U1019, Lille, France.|7 Institut Fédératif de la Recherche 142, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gosset
authors.affiliation: 8 Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU de Lille, Université Nord de France, Lille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Deschildre
authors.affiliation: 1 AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France.
authors.forename: Rola
authors.initials: R
authors.lastname: Abou-Taam
authors.affiliation: 9 Cabinet La Berma, Antony, France; and.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mahut
authors.affiliation: 10 APHP, Hôpital Armand Trousseau, Service d'Explorations Fonctionnelles Respiratoires, Paris, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Beydon
authors.affiliation: 1 AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France.|2 Université Paris Descartes, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: de Blic
mesh_terms: D056151:Airway Remodeling / Q000502:physiology*; D001706:Biopsy; D001980:Bronchi / Q000473:pathology / Q000503:physiopathology; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012135:Respiratory Sounds / Q000503:physiopathology*; D012720:Severity of Illness Index
keywords: airway remodeling; bronchial biopsy; children; preschool asthma; severe recurrent wheeze