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J Allergy Clin Immunol. 2013 Apr;131(4):1024-32, 1032.e1-16. doi: 10.1016/j.jaci.2012.08.044. Epub 2012 Oct 12.

Increased airway smooth muscle in preschool wheezers who have asthma at school age.

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1
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, United Kingdom.

Abstract

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.

CONCLUSION:

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.

PMID:
23069488
DOI:
10.1016/j.jaci.2012.08.044
[Indexed for MEDLINE]
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