Asthma and lower airway diseasePediatric severe asthma is characterized by eosinophilia and remodeling without TH2 cytokines
Section snippets
Subjects
Children aged 5 to 16 years referred to Royal Brompton Hospital with problematic severe asthma between April 2005 and June 2009 were included.6 Definitions of poor control and entry criteria were as follows:
- 1.
persistent (most days for ≥3 months) chronic symptoms (which prompt use of short-acting β2-agonists ≥3 times per week) of airway obstruction despite high doses of inhaled corticosteroids (ICSs; ≥800 μg/d budesonide equivalent) and/or regular oral corticosteroids, long-acting β2-agonists, and
Demographics
Of 104 patients referred with problematic severe asthma, 51 were classified as having difficult asthma (Fig 1). Fifty-three (51%) of 104 patients with true STRA were further investigated. The clinical characteristics of subjects are shown in Table I. Forty-five (85%) of 53 patients with STRA were atopic compared with 7 (47%) of 15 control subjects (P < .01). The median baseline FEV1 in patients with STRA was 68.5% (interquartile range [IQR], 54.8% to 86.5%) of predicted value compared with 94%
Discussion
In this large pediatric bronchoscopic study, an important novel facet is the use of prior detailed evaluation to exclude as far as possible all those who were nonadherent or had other confounding issues. We have shown that, unlike in adults,28, 29, 30 STRA in children is characterized by eosinophilic and not neutrophilic airway inflammation, there is no mast cell myositis,31 and the eosinophilic inflammation is not driven by signature TH2 cytokines in most patients.9
Quantification of BAL fluid
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Cited by (0)
J.F. was funded by an Asthma UK Foundation Grant and a grant from the Royal Brompton & Harefield Biomedical Research Unit. S.S. is funded by the Wellcome Trust, UK, grant no. 083586/Z/07/Z. N.R. is the recipient of a European Respiratory Society Fellowship (no. 64) and a grant of the Swiss National Science Foundation (no. 1172/05b). The project was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.
Disclosure of potential conflict of interest: A. Gupta receives research support from the British Medical Association. N. Regamey is on advisory boards for Merck-Sharp and Dome and Novartis. C. M. Lloyd is a consultant for MedImmune. The rest of the authors declare that they have no relevant conflicts of interest.