Bronchial Remodeling-based Latent Class Analysis Predicts Exacerbations in Severe Preschool Wheezers

Bronchial smooth muscle remodelling impacts the exacerbation frequency of severe preschool wheezers

“…However, even if our bronchial remodelling-based latent classes identified patients at increased risk of subsequent exacerbations, it failed to distinguish patients without exacerbations or those with infrequent exacerbations (i.e. , one or two) in the year following fibreoptic bronchoscopy (14).…”

“…This post-hoc study pooled the eighty severe preschool children (1-5 years old) with analysable bronchial biopsies from the "P'tit Asthme" and the "RESPIRE" studies (Ndeg NCT02806466 and NCT04558671 atClinicalTrials.gov ) (14). The design, inclusion criteria, and procedures for these studies have been previously described (14).…”

“…Previous studies also demonstrated that the risk of subsequent exacerbations in preschool wheezers was increased in patients previously hospitalized for severe wheezing exacerbation (12,13). Using bronchial remodelling-based latent class analysis, we recently identified two classes of severe preschool wheezers, one being characterized by a decreased reticular basement membrane (RBM) to bronchial smooth muscle (BSM) distance, submucosal fibrosis area, mucus gland area, and an increased BSM area, density of blood vessels, and RBM thickness compared to the other (14). This class was at increased risk of frequent subsequent exacerbations (i.e ., 3 or more in the year following fibreoptic bronchoscopy) despite not being significantly different from the second class in terms of clinical, biological or BALF parameters at baseline (14).…”

“…Using bronchial remodelling-based latent class analysis, we recently identified two classes of severe preschool wheezers, one being characterized by a decreased reticular basement membrane (RBM) to bronchial smooth muscle (BSM) distance, submucosal fibrosis area, mucus gland area, and an increased BSM area, density of blood vessels, and RBM thickness compared to the other (14). This class was at increased risk of frequent subsequent exacerbations (i.e ., 3 or more in the year following fibreoptic bronchoscopy) despite not being significantly different from the second class in terms of clinical, biological or BALF parameters at baseline (14). However, even if our bronchial remodelling-based latent classes identified patients at increased risk of subsequent exacerbations, it failed to distinguish patients without exacerbations or those with infrequent exacerbations (i.e.…”

Remodeling Phenotypes Take Center Stage in the Prediction of Preschool Wheeze Attacks

“…In this issue of the Journal , Fayon and colleagues (pp. 416–426 ) have, for the first time, demonstrated the role of a cluster of features of remodeling that predict exacerbations of severe wheeze in the year after biopsy ( 8 ). They have incorporated epithelial integrity, RBM thickness, mucus glands, fibrosis, BSM area, density of blood vessels, and RBM–BSM distance as markers of remodeling.…”