Chest
Clinical InvestigationsAsthmaHistopathology of Severe Childhood Asthma: A Case Series
Section snippets
Bronchoscopy and Biopsy Sample Processing
Flexible bronchoscopy was carried out using standard pediatric techniques.5 The safety of this procedure in severe asthmatics has been documented.6 For children < 12 years of age (depending on body size), the Olympus BF-3C20 (Melville, NY) [outer diameter, 3.7 mm] or the BF-3C40 (outer diameter, 3.6 mm) fiberoptic bronchoscopes were used; for adolescents, the Olympus BF-40 (outer diameter, 5.9 mm, suction channel 2.2 mm) was used. Patients underwent conscious sedation using IV narcotics
Historical and Clinical Data
The cohort studied included six children (three whites and three African Americans) evaluated at National Jewish Medical and Research Center (NJMRC) from 1993 to 1998 for evaluation of severe, persistent, steroid-dependent asthma and who underwent a clinically indicated bronchoscopy with endobronchial biopsy. The decision to perform bronchoscopy was at the discretion of the attending physician. The bronchoscopies were performed in every case to rule out other respiratory conditions and/or to
Discussion
Airway remodeling is a distinctive pathologic feature of asthma,1 and is thought to be the result of an aberrant reparative process associated with ongoing allergic inflammation. The histopathologic changes that occur within the airways of asthmatics include epithelial desquamation and regeneration, goblet-cell hyperplasia, submucosal gland hypertrophy, subepithelial fibrosis or thickening of the basement membrane, inflammatory cell infiltration, hyperplasia and hypertrophy of the bronchial
ACKNOWLEDGMENT
The authors thank Jan Henson for preparing the biopsy specimens, and all of the children with severe asthma and their parents who have been evaluated at National Jewish Medical and Research Center.
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