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Copyright ©ERS Journals Ltd 2002
Transbronchial biopsy as a tool to evaluate small airways in asthma
National Jewish Medical and Research Centre, the University of Colorado Health Sciences Center, Denver, CO, USA
CORRESPONDENCE: S. Balzar, National Jewish Medical and Research Center, 1400 Jackson St., D 203, Denver, CO, 80206, USA. Fax: 1 3033981851. E-mail: balzars@njc.org
Keywords: asthma/pathology, asthma/inflammation, bronchoscopy
Received: July 18, 2001
Accepted April 3, 2002
This study was supported by grant AI–40600 and American Lung Association of Colorado and Oklahoma, USA.
Small airway (SA) inflammation in asthmatics is poorly understood. Surgical biopsies to obtain peripheral lung tissue are seldom justified in asthmatics. Therefore, the authors hypothesised that transbronchial biopsy could be an alternative approach to evaluate SA in asthma.
Transbronchial and endobronchial biopsy tissue samples (TBBX and EBBX) from 12 severe asthmatics were evaluated for airway and parenchymal total inflammatory cell count expressed as the sum of immunostained T-cells (CD3), macrophages (CD68), mast cells (tryptase AA1), neutrophils (neutrophil elastase) and eosinophils (EG2) per mm2. The large airways (LA) were evaluated in EBBXs, while SA, medium airways (MA) and alveolar tissue (AT) were evaluated in TBBXs.
When cell counts from SA, MA, LA and AT were compared, SA had a significantly higher cell count than MA or LA (SA 1011·mm–2 (539–1,290), MA 346·mm–2 (223–415), LA 332·mm–2 (189–416), AT 464·mm–2 (298–834)). The cell density and pattern of the inflammatory cell distribution in subjects with TBBXs appeared similar to those in three severe asthmatics whose inflammatory cells were analysed in surgical tissue samples.
This study suggests that small airway may be identified and analysed in transbronchial biopsy tissue samples and therefore transbronchial biopsy tissue samples could expand the analysis of inflammation and tissue remodelling in asthma.
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