Abstract
<h2>Abstract</h2><h3>Background</h3> Difficult asthma in children displays distinct clinical patterns, and its physiopathology remains poorly understood. <h3>Objective</h3> To determine the characteristics of the bronchial inflammatory profile in children with difficult asthma. <h3>Methods</h3> We performed endobronchial biopsy and bronchoalveolar lavage in 28 children with persistent bronchial obstruction despite high doses of inhaled corticosteroids and regular treatment with long-acting β<sub>2</sub>-agonists: 13 had persistent symptoms and 15 had few or no symptoms. <h3>Results</h3> The number of eosinophils (<i>P</i> = .03) and neutrophils (<i>P</i> = .04) in the epithelium was significantly higher in symptomatic children than in children with few symptoms. Reticular basement membrane thicknening was similar in both groups. IFNγ levels (<i>P</i> = .03) and IFNγ/IL-4 ratio (<i>P</i> = .01) were significantly higher in children with few symptoms. <h3>Conclusions</h3> In symptomatic children, T<sub>H</sub>2-type inflammation was associated with the presence of activated eosinophils in the epithelium, whereas asthma in children with few symptoms was associated with an increase in T<sub>H</sub>1 cytokine levels. The high levels of IFNγ suggest that this T<sub>H</sub>1 cytokine may modulate the local inflammatory response.
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