RT Journal Article
SR Electronic
T1 Investigation of young children with severe recurrent wheeze: any clinical benefit?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 29
OP 35
DO 10.1183/09031936.06.00030605
VO 27
IS 1
A1 S. Saglani
A1 A. G. Nicholson
A1 M. Scallan
A1 I. Balfour-Lynn
A1 M. Rosenthal
A1 D. N. Payne
A1 A. Bush
YR 2006
UL http://erj.ersjournals.com/content/27/1/29.abstract
AB The management of young children with severe recurrent wheeze is difficult because symptoms are often refractory to conventional asthma therapy and other diagnoses must be excluded. The present authors aimed to evaluate the outcome of detailed, invasive investigations in such patients. Children aged between 3 months and 5 yrs with severe recurrent wheezing, who had been referred to a tertiary centre, underwent a protocol of investigations including a chest computed tomography scan, blood tests, nasal ciliary brushings, fibreoptic bronchoscopy, bronchoalveolar lavage (BAL), endobronchial biopsy and passage of an oesophageal pH probe. A total of 47 children (25 males) with a median age of 26 (range 5–58) months underwent investigation. Of these, 39% were atopic, two-thirds had evidence of gastro-oesophageal reflux and 37 out of 47 had an abnormal bronchoscopy. Findings included structural abnormalities (13 out of 37), excessive mucus (20 out of 37) and macroscopic inflammation (10 out of 37). BAL revealed bacterial growth in 12 out of 44 (27%) patients. Good quality endobronchial biopsies were obtained from 36 out of 46 (78%) patients; of these, 44% had tissue eosinophila and 28% had a thickened reticular basement membrane. Additional investigations (including bronchoscopy) in young children with severe wheeze may help to identify positive diagnoses and provide information to support a clinical diagnosis of asthma. This hypothesis-generating work should form the basis of future interventional studies.