PT  - JOURNAL ARTICLE
AU  - James Cook
AU  - Andrew Bush
AU  - Sejal Saglani
AU  - Louise Fleming
TI  - Higher doses of inhaled steroid are associated with bacterial bronchitis in children with severe therapy resistant asthma (STRA)
AID  - 10.1183/13993003.congress-2016.OA4802
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - OA4802
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/OA4802.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/OA4802.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Background Bacterial airway infection is increasingly being considered important in acute asthma [Bisgaard H et al. BMJ 2010; 341: c4978]. We hypothesised that it may also contribute to control in STRA.Methods Retrospective review of children with STRA undergoing elective bronchoscopy with bronchoalveolar lavage (BAL). All children were assessed as part of a structured protocol and potentially modifiable management issues addressed. Asthma control including spirometry, exhaled nitric oxide (FeNO) and Asthma Control Test (ACT) were assessed on the day of bronchoscopy. Comparison between the cohorts with positive and negative BAL cultures was made with Mann-Whitney and Chi squared tests.Results 109 children, 64 (57%) male were identified. 22 (20%) had a positive BAL bacterial culture. The most common organisms were haemophilus, pneumococcus and staph aureus. The positive culture group were significantly younger. A positive culture was associated with a higher maintenance dose of inhaled steroid, lower FEV1, and higher BAL neutrophils. [figure 1] Despite the higher ICS dose there was no difference in FeNO or ACT between the groups.Conclusion STRA children with positive BAL cultures have more severe disease. Further work is needed to determine whether the higher dose of ICS increases the risk of infection or whether infection contributes to relative steroid insensitivity.