Features of Cytological Profile of Induced Sputum in School-Age Children with Exercise-Induced Bronchial Asthma
On the basis of Regional children’s clinical hospital of Chernivtsi, in 41 school-age children with persistent bronchial asthma (BA), the nature of airways inflammation has been studied with the aim of differential choice of anti-inflammatory basic therapy. The first (I) clinical group consisted of 22 children with exercise-induced BA phenotype, and the other 19 patients without a phenotype of exercise-induced BA were included in the second (II) clinical group. Cytological analysis of induced sputum was conducted by I.D. Pavord method (1996).
Patients with exercise-induced BA are characterized by hypogranulocytic inflammation of the airways, with a predominance of eosinophil-mediated reactions associated with hyperlymphocytic infiltration of the bronchi. So, bronchial eosinophilia (≥ 2 % of eosinophils in the sputum) was registered in 81.8 % of pupils in group I and in 63.2 % — in group II (Pϕ > 0.05). Meanwhile, hyperlymphocytic (number of lymphocytes in the cellular sediment of the sputum ≥ 11 %) inflammatory response of the airways was recorded twice as often in patients with exercise-induced BA (22.7 % of children) compared to group II patients (10.5 %) (Pϕ > 0.05).
In patients without exercise-induced BA phenotype, a significant neutrophilic inflammatory response of the airways (relative content of neutrophils in the induced sputum ≥ 69 %) was three times more likely (36.8 % of cases) in comparison with patients from the I clinical group (13.6 %) (Pϕ < 0.05). At the same time, the neutrophilic type of the airway inflammatory response was associated with a significant damage of the bronchial mucosa, which manifested by an increase in the number (≥ 40 % of the cylindrical epithelial cells in the induced sputum) of desquamated epithelium in this cohort of patients (68.4 %) compared to group I (40.9 % of children; Pϕ < 0.05).
Bezrukov L.O. Porivnyal'nyy analiz tsytolohichnoho skladu mokrotynnya shkolyariv, khvorykh na bronkhial'nu astmu, pry eozynofil'nomu ta neytrofil'nomu kharakteri zapalennya dykhal'nykh shlyakhiv / L.O. Bezrukov, O.K. Koloskova, Ye.P. Ortemenka // Zdorov'e rebenka. – № 2(37). - 2012. – S. 28- 30. http://www.mif-ua.com/archive/article/27254
Vybrani pytannya diahnostyky ta likuvannya bronkhial'noyi astmy v ditey / za red. prof. Bezrukova L.O., prof. Koloskovoyi O.K. – Chernivtsi: «Misto», 2011. – 248 s.
Toyran M., Bakirtas A., Dogruman-Al F. et al. Airway inflammation and bronchial hyperreactivity in steroid naive children with intermittent and mild persistent asthma. Pediatric Pulmonology 2014; 49(2):140–147. doi: 10.1002/ppul.22810.
Parsons J.P., Hallstrand T.S., Mastronarde J.G., Kaminsky D.A., Rundell K.W., Hull J.H. et al. An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction. Am J Respir Crit Care Med 2013; 187(9):1016–1027. doi: 10.1164/rccm.201303-0437ST/
Chipps B.E., Bacharier L.B., Harder J.M. Phenotypic expression of childhood weezing and asthma: implications for therapy. J Pediatrics 2011; 158(6):878-884. doi: 10.1016/j.jpeds.2011.01.057.
Cho J.Y. Recent advances in mechanisms and treatments of airway remodeling in asthma: a message from the bench side to the clinic. Korean J Intern Med 2011; 26 (4):367-383. http://dx.doi.org/10.3904/kjim.2011.26.4.367
Damera G., Panettieri R.A. Does airway smooth muscle express an inflammatory phenotype in asthma? Br J Pharmacol 2011; 163 (1):68-80. DOI:10.1111/j.1476-5381.2010.01165.x
Fixman E.D., Stewart A., Martin J.G. Basic mechanisms of development of airway structural changes in asthma. Eur Respir J 2007;29: 379–389. doi: 10.1183/09031936.00053506
Hallstrand T.S. New insights into pathogenesis of exercise-induced bronchoconstriction. Curr Opin Allergy Clin Immunol 2012; 12(1):42–48. doi: 10.1097/ACI.0b013e32834ecc67.
Lopesa W.A., Leite N., Rosário N. Exercise-induced bronchospasm in obese and non-obese asthmatic adolescents. Rev Paul Pediatr 2010; 28(1):36-40. http://www.scielo.br/pdf/rpp/v28n1/en_v28n1a07.pdf
Shifren A., Witt C., Christie C., Castro M. Mechanisms of Remodeling in Asthmatic Airways. J Allergy (Cairo) 2012; Article ID 316049: e1-12. doi: 10.1155/2012/316049.
Practice Parameter: Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter / Annals of allergy, asthma & immunology 2010; 105: S1-S47. doi:10.1016/j.anai.2010.09.021
Duong MyL., Subbarao P., Adelroth M.E., Obminski G., Strinich T., Inman M., Pedersen S., O’Byrne P.M. Sputum Eosinophils and the Response of Exercise-Induced Bronchoconstriction to Corticosteroid in Asthma. Chest 2008; 133:404–411) DOI 10.1378/chest.07-2048
Vieira M.O., Pizzichini E., Steidle L.J. et al. Sputum induction in severe exacerbations of asthma: safety of a modified method. Eur Respir J 2011; 38 (4):979-980. doi: 10.1183/09031936.00029511.
Zedan M., Attia G., Zedan M.M., Osman A. et al. Clinical asthma phenotypes and therapeutic responses. ISRN Pediatrics 2013; 2013: e1-7. doi: 10.1155/2013/824781.
Zedan M., Laimon W.N., Osman A.M., Zedan M.M. Clinical asthma phenotyping: A trial for bridging gaps in asthma management. World J Clin Pediatr 2015; 4(2):13-18. doi: 10.5409/wjcp.v4.i2.13
- There are currently no refbacks.
Copyright (c) 2016 CHILD`S HEALTH
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2018