Journal
CLINICAL AND EXPERIMENTAL ALLERGY
Volume 48, Issue 7, Pages 806-813Publisher
WILEY
DOI: 10.1111/cea.13143
Keywords
Severe asthma; Preschool wheezers; Airway inflammation; Airway remodeling; Eosinophils; Lung function; Asthma outcome
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BackgroundThe influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood. ObjectiveTo assess their association with asthma symptoms and lung function at school age. MethodsPreschoolers (38.4 months) initially investigated with bronchial biopsies were re-assessed for asthma symptoms and lung function at school age. ResultsThirty-six of 49 preschoolers (73.5%) were assessed at 10.9 years. Twenty-six (72.2%) had persistent asthma. Submucosal eosinophil counts were higher in children with severe exacerbations at school age than in those without (16/0.1 mm(2) [11.2-30.4] vs 8/0.1 mm(2) [2.4-17.6], P = .02), and correlated with the number of severe exacerbations (P = .04, r = .35). Submucosal neutrophil counts correlated with FEV1/FVC (P < .01, r = .47) and FEF25-75% predicted (P = .02, r = .43). Airway smooth muscle (ASM) area correlated with FEV1/FVC (P < .01, r = .51). Vessel numbers negatively correlated with FEV1% predicted and FEV1/FVC (P = .03, r = -.42; P = .04, r = -.41; respectively) and FEF25-75% predicted (P = .02, r = -.46). ConclusionEosinophilic inflammation in preschoolers with severe recurrent wheeze might be predictive of future severe exacerbations, neutrophilia might be associated with better lung function. Changes in ASM and vascularity might affect lung function at school age.
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