Bronchoalveolar lavage in asthmatic children: Evidence of neutrophil activation in mild‐to‐moderate persistent asthma

Barbato, Angelo; Panizzolo, C.; Gheno, Marta; Sainati, Laura; Favero, Elisabetta; Faggian, Diego; Giusti, F; Pesscolderungg, Lidia; Rosa, Mario La

doi:10.1034/j.1399-3038.2001.012002073.x

Cited by 30 publications

(33 citation statements)

References 16 publications

(20 reference statements)

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“…(13,17) However, various authors have also confirmed the participation of neutrophils in the bronchial inflammation found in asthma patients and, especially, in wheezing infants, (15)(16)(17)(18)(19) regardless of the presence of bacterial infection. Various studies (14,15,18,20) have associated the increase in the number of neutrophils with greater severity of symptoms.…”

Section: Cystic Fibrosismentioning

confidence: 99%

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

2010

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The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators) as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%), lymphocytes (approximately 10%), neutrophils (approximately 2%) and eosinophils (< 1%). The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of various lung diseases. Less invasive than transbronchial and open lung biopsies, BAL has great clinical value. Further studies adopting standard international protocols should be carried out. Such studies should involve various age groups and settings in order to obtain reference values for BAL fluid cell profiles, which are necessary for a more accurate interpretation of findings in children and adolescents with lung diseases.Keywords: Bronchoalveolar lavage; Bronchoalveolar lavage fluid/cytology; Child; Adolescent. ResumoEste estudo teve como objetivo rever a literatura existente sobre a celularidade do LBA em crianças e adolescentes saudáveis, bem como sobre sua utilização como método propedêutico e de acompanhamento nas afecções pulmonares neste grupo etário. Para tanto, utilizamos o banco de dados médico Medline com a seleção de artigos publicados entre 1989 e 2009 utilizando os seguintes descritores MeSH com operadores boolianos: bronchoalveolar lavage AND cytology OR cell AND child. Em crianças saudáveis, a celularidade é composta por macrófagos alveolares (> 80%), linfócitos (cerca de 10%), neutrófilos (cerca de 2%) e eosinófilos (< 1%). O perfil celular sofre alterações de acordo com a doença estudada. Ocorre uma elevação no número de neutrófilos em sibilantes, especialmente os não atópicos, bem como em indivíduos com quadros infecciosos e inflamatórios pulmonares, incluindo fibrose cística e doenças intersticiais pulmonares. Os eosinófilos se elevam em crianças/adolescentes com asma e podem atingir níveis acentuados na aspergilose broncopulmonar alérgica e nas síndromes hipereosinofílicas. A elevação dos linfócitos pode ocorrer em um grupo heterogêneo de doenças. Conclui-se que a...

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Section: Cystic Fibrosismentioning

confidence: 99%

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

2010

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“…The role of airway neutrophils in the pathogenesis of persistent asthma despite mild/moderate inhaled corticosteroid (ICS) doses has not been established. However, more recent data confirm considerable heterogeneity of the asthma phenotype and many subjects may exhibit an airway disease characterised by sputum neutrophilia rather than an eosinophilic inflammatory pattern [7][8][9].In-vitro data suggest that long-acting b 2 -agonists (LABAs) may have a neutrophil modulatory effect and such an effect could explain the reductions in asthma exacerbations seen with LABAs [10]. A significant decrease in activated eosinophil numbers in ICS-treated, but still symptomatic, asthmatic subjects following introduction of salmeterol xinafoate has previously been described [11].…”

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confidence: 99%

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Possible anti-inflammatory effect of salmeterol against interleukin-8 and neutrophil activation in asthmain vivo

Reid¹,

Ward²,

Wang³

et al. 2003

Eur Respir J

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In-vitro data suggest that long-acting b 2 -agonists may have a neutrophilstabilising effect. A reduction in airway wall eosinophil number following introduction of salmeterol in persistent asthma has previously been described. There is currently interest in the "neutrophil system" in asthma, and thus the aim of the present study was to investigate the effect of salmeterol on interleukin (IL)-8, neutrophils and myeloperoxidase (MPO) in persistent asthma.In the same 12-week double-blind parallel-group placebo-controlled study as described previously, the effects on bronchoalveolar lavage fluid (BALF) IL-8, neutrophils and MPO of introducing salmeterol (50 mg b.i.d.) or giving additional inhaled corticosteroid (fluticasone 100 mg b.i.d.) in 45 subjects with persistent asthma already on low/moderate doses of inhaled corticosteroids were further investigated.At baseline, BALF IL-8 but not neutrophil or MPO levels were significantly raised in the asthmatic subjects compared to normal controls. MPO levels correlated strongly with IL-8 levels, and weakly with BALF neutrophil numbers in the asthmatics. Fluticasone treatment resulted in significantly elevated neutrophil numbers, but not MPO or IL-8 levels. In contrast, introducing salmeterol significantly reduced IL-8 and MPO levels, but did not affect BALF neutrophil numbers. Interestingly, salmeterol and fluticasone showed significantly contrasting effects on MPO and neutrophils, and there was a divergent effect on IL-8 levels that almost reached significance.Excessive interleukin-8 levels may be relevant to asthma pathogenesis, even in the setting of moderate-dose inhaled corticosteroid therapy. Reduction in interleukin-8 production and possibly stabilisation of airway neutrophil numbers may explain the greater clinical benefit of adding a long-acting b 2 -agonist rather than merely increasing inhaled corticosteroid doses. Indeed, high-dose inhaled corticosteroid therapy alone may promote airway neutrophilia. Asthma is characterised by airway inflammation, bronchial hyperresponsiveness and reversible airflow obstruction. The asthmatic inflammatory response consists of infiltration into the airway of a variety of activated inflammatory cells with release of mediators of asthma pathophysiology. The eosinophil has an established role as an effector cell in asthma but the pro-inflammatory role of other granulocytes, in particular the neutrophil, remains less well defined [1,2].Increased numbers of airway neutrophils have been described in severe steroid-dependent asthma, during acute exacerbations and in cases of sudden-onset fatal disease [3][4][5]. An increase in neutrophil activation, but not numbers, in mild chronic asthma has previously been shown [6]. The role of airway neutrophils in the pathogenesis of persistent asthma despite mild/moderate inhaled corticosteroid (ICS) doses has not been established. However, more recent data confirm considerable heterogeneity of the asthma phenotype and many subjects may exhibit an airway disease characterised by sputu...

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“…In the retrospective study, MPO concentrations were significantly raised in children with asthma compared with "controls," with significantly higher levels being found in children with persistent compared with episodic asthma [55]. Although IL-8 levels are reported to be similar in children with asthma, infantile wheeze, and "controls," IL-8 levels increased with the symptom score [57].…”

Section: Neutrophil Numbers and Neutrophil-derived Mediators In The Amentioning

confidence: 96%

“…with episodic asthma [55]. In a prospective study, neutrophils were increased in approximately 33% of children with asthma and 50% of those with infantile wheeze compared with control values, although statistical significance was only found in the latter group [56].…”

Section: Neutrophil Numbers and Neutrophil-derived Mediators In The Amentioning

confidence: 97%

Neutrophils in asthma pathophysiology

Ennis

2003

Curr Allergy Asthma Rep

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Although the role of eosinophils, mast cells, and T cells in asthma has long been recognized, several reports suggest that neutrophils may also be involved. In most studies of people with mild asthma, neutrophil numbers in the airways are not different from controls. However, in severe asthma, including asthma deaths, neutrophils are usually raised. Furthermore, most pediatric studies suggest that neutrophils are raised in some children, in particular in the young or infantile wheeze group. Measurements of inflammatory mediators in the airways of asthmatic subjects suggest that neutrophils are activated.

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Bronchoalveolar lavage in asthmatic children: Evidence of neutrophil activation in mild‐to‐moderate persistent asthma

Cited by 30 publications

References 16 publications

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Possible anti-inflammatory effect of salmeterol against interleukin-8 and neutrophil activation in asthmain vivo

Neutrophils in asthma pathophysiology

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