Abstract
BackgroundWheezing is a common symptom in early childhood. However, refractory wheezing is difficult to treat, and it may thus account for extensive use of medical resources. It is therefore important to improve our understanding of the pathophysiology of refractory childhood wheezing.MethodsIn this descriptive study, we studied 156 children with refractory wheezing using fiberoptic bronchoscopy and bronchoalveolar lavage (BAL), and compared the results with a control group of 46 children with various pulmonary diseases but no wheezing. Etiology and cell classification were analyzed for each BAL sample.ResultsOverall, 21.8 % of children with refractory wheezing had airway malformations including tracheomalacia, airway stenosis, and tracheal bronchus. The incidence of airway malformations increased to 31 % in infants under 12 months of age. A significant increase in neutrophil ratio and decrease in macrophage ratio were observed in BAL from children with refractory wheezing compared with controls. Pathogen infection led to a higher ratio of neutrophils in the wheezing group compared with controls. However, there were no significant differences in neutrophil ratios among children with various pathogen infections. Furthermore, children with refractory wheezing had a high rate of Mycoplasma pneumoniae infection.ConclusionsAirway malformations might play an important role in children under 3 years of age with refractory wheezing, especially in infants under 12 months of age. Neutrophil-mediated airway inflammation was characteristic of refractory wheezing in children under 3 years of age. In addition, infections such as M. pneumoniae may aggravate airway inflammation and affect refractory wheezing.
Highlights
Wheezing is a common symptom in early childhood
The aim of this study was to determine the cellular profile of bronchoalveolar lavage (BAL) from infants with refractory wheezing in the Suzhou area, China, and to investigate airway malformations and neutrophil ratios to determine if ongoing inflammation plays a role in the development of this condition
The neutrophil ratio was significantly higher and the lymphocyte ratio significantly lower in the wheezing group compared with the controls (36.82 ± 14.97 vs 29.00 ± 13.47 and 53.38 ± 14.38 vs 60.31 ± 13.22, respectively, P < 0.001)
Summary
Wheezing is a common symptom in early childhood. Wheezing in early childhood is a common but poorly characterized symptom, with a third of infants reported to experience multiple episodes of wheezing in their first 3 years [1]. Congenital malformations of the lungs and airways are among several causes of irreversible airway obstruction in children who may develop various symptoms such as recurrent wheezing, cough, recurrent lower airway infection, severe dyspnea, and respiratory insufficiency [4,5,6,7]. We speculate that airway morphology may play an important role in refractory wheezing. The aim of this study was to determine the cellular profile of BAL from infants with refractory wheezing in the Suzhou area, China, and to investigate airway malformations and neutrophil ratios to determine if ongoing inflammation plays a role in the development of this condition
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