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Bronchoalveolar Lavage Profiles in Uncontrolled Wheezy Children Compared by Asthma Predictive Index
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  • Dima Ezmigna,
  • Mark Brown,
  • Cori Daines,
  • Wayne Morgan
Dima Ezmigna
University of Florida
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Mark Brown
University of Colorado Denver School of Medicine
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Cori Daines
University of Arizona College of Medicine
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Wayne Morgan
The University of Arizona College of Medicine Tucson
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Abstract

The Asthma Predictive Index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive(+ve)/negative(-ve) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API (+ve) and neutrophils in API (-ve) groups respectively. Objective: To compare bronchoalveolar lavage (BAL) cell profiles in API (+ve)/(-ve) children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS). Design: A retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API +ve ; 12 API -ve). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages (LLM) were analyzed. Cell counts presented as median (range). Results: Neutrophil percentages were increased in both groups [API -ve 16% (1-76%); API +ve 42% (1-95%); P=NS]. Cell percentages were similar for lymphocytes [API-ve 12% (1-30%); API +ve 7% (1-37%)], and macrophages [API -ve 67.5% (12-97%); API +ve 41 % (2-94%)]. Eosinophil percentages were low in both groups [API -ve 1 % (1-2%); API +ve 1 % (1-11%)]. Bacterial cultures were positive in 16 (80%) API +ve and 4 (33%) API -ve patients (P=0.10). Conclusion: Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Positive correlation between neutrophil percentages and positive bacterial cultures was seen independent of API. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to inhaled corticosteroid therapy regardless of API status with a trend to more positive cultures in API positive children.

Peer review status:IN REVISION

14 Apr 2021Submitted to Pediatric Pulmonology
15 Apr 2021Assigned to Editor
15 Apr 2021Submission Checks Completed
16 Apr 2021Reviewer(s) Assigned
04 May 2021Review(s) Completed, Editorial Evaluation Pending
05 May 2021Editorial Decision: Revise Major