Study objective: To determine the cell profile of BAL from infants with severe recurrent wheezing who were not acutely ill at the time of investigation, suggesting an ongoing inflammation.
Design and patients: In a retrospective study, we determined BAL cell profiles for 83 children with wheezing aged 4 to 32 months (mean ± SD, 11.3 ± 5.5 months). Fiberoptic bronchoscopy was performed in children with severe recurrent wheezy bronchitis unresponsive to inhaled steroids. These children were compared with 17 children aged 6 to 36 months (mean, 15.1 ± 7.5 months) with various nonwheezing pulmonary diseases. Children were included as control subjects if they had no endobronchial inflammation and no atopy.
Results: The BAL cell profile of young children with wheezing typically includes a significantly higher cell count (mean, 644.4 ± 956.8 × 103/mL vs 313 ± 203.2 × 103/mL, p = 0.008), a significantly higher percentage of neutrophils (mean, 9 ± 12.1% vs 2.1 ± 2.2%, p = 0.003), and a higher neutrophil count (mean, 43.2 ± 81.6 × 103/mL vs 7.9 ± 11.8 × 103/mL, p = 0.003), as compared with control subjects. The larger number of neutrophils in children with wheezing was not correlated with bacterial or viral infection, or with age, sex, or atopic status. In contrast to the situation in asthmatic adults, eosinophil levels were not higher in children with wheezing than in control subjects (mean, 0.09 ± 0.27% vs 0.08 ± 0.25%).
Conclusion: Neutrophil-mediated inflammation in the airways appears to better characterize severe recurrent wheezing in children < 3 years old.