PURPOSE: It is well documented that passive smoke exposure exacerbates asthma in children. The purpose of the study was to determine a correlation between passive smoke exposure (PSE) in children and the presence of lipid laden macrophages (LLM), a marker of inflammation and aspiration, in bronchoalveolar lavage (BAL) fluid obtained during fiberoptic bronchoscopy (FOB).
METHODS: The charts of ninety-three children, aged 57 days to 17 years, that underwent fiberoptic bronchoscopy with BAL within the last fourteen months, were retrospectively reviewed. The subjects were broken down into two groups; < 5 years and those ≥ than 5 years of age. It was assumed that in the school aged child, the amount of time exposed to smoke would be less than in those children who stayed home.
RESULTS: Of the forty one children less than 5 years old, 13 had PSE and 28 did not. LLM were present in 46.1% of children with PSE and in 46.4% of those subjects without. Seventeen children greater to or equal than five years of age had PSE and thirty five did not. Of the seventeen with PSE, eleven (64.7%) had LLM present in BAL fluid. Sixteen children (45.7%) without a history of PSE had LLM in their BAL fluid.The average LLM was 1.46 for non-PSE patients and 1.39 for PSE patients.< 5yrs5-10 yrs10-15 yrs>15 yrs.
CONCLUSION: Although PSE appears to induce airway inflammation in children < 5 years old, the amount of LLM is not significantly different than in those without PSE. This may be due to the prevalence of reflux with aspiration in younger children triggering airway inflammation. In children ≥ 5 years of age, the environment may play a role in the presence of inflammation. Further investigation should take into consideration each patient’s underlying respiratory condition as well as the extent of smoke exposure in each subject’s household.
CLINICAL IMPLICATIONS: Due to their lack of specificity, LLM should not be used as a marker of inflammation in children with PSE, especially in non-school aged children.
DISCLOSURE: Stamatia Alexiou, No Financial Disclosure Information; No Product/Research Disclosure Information