Persistent Wheezing in Very Young Children Is Associated with Lower Respiratory Inflammation

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Abstract
Despite advances in understanding the pathophysiology of asthma, morbidity and mortality in pediatrics continue to rise. Little is known about the initiation and chronicity of inflammation resulting in asthma in this young population. We evaluated 20 “wheezing” children (WC) (median age 14.9 mo) with a minimum of two episodes of wheezing or prolonged wheezing ⩾ 2 mo in a 6-mo period with bronchoscopy and bronchoalveolar lavage (BAL). Comparisons were made with six normal controls (NC) (median age 23.3 mo) undergoing general anesthesia for elective surgery. BAL fluid cell counts and differentials were determined. The eicosanoids, leukotriene (LT) B4, LTE4, prostaglandin (PG)E2, and 15-hydroxyeicosatetraenoic acid (HETE) and the mast cell mediators, β -tryptase and PGD2, were evaluated by enzyme immunoassay (EIA). WC had significant elevations in total BAL cells / ml (p = 0.01), as well as, lymphocytes (LYMPH, p = 0.007), macrophages / monocytes (M&M, p = 0.02), polymorphonuclear cells (PMN, p = 0.02), epithelial cells (EPI, p = 0.03), and eosinophils (EOS, p = 0.04) compared with NC. Levels of PGE2 (p = 0.0005), 15-HETE (p = 0.002), LTE4 (p = 0.04), and LTB4 (p = 0.05) were also increased in WC compared with NC, whereas PGD2 and β -tryptase were not. This study confirms that inflammation is present in the airways of very young WC and may differ from patterns seen in adults with asthma.