Lower airway microbiota and mycobiota in children with severe asthma

Fungi can affect various processes that directly promote asthma including dendritic cell processing, production of TH2-associated cytokines, and mucin production.2 Epidemiologic and some treatment studies highlight a potential association between fungal sensitization and SA. We therefore set about to analyze both the bacterial and fungal populations in the lungs of children with and without SA. Analyses were performed on bronchoalveolar lavage (BAL) pellets from children who underwent bronchoscopy over a 20-month period. Pneumocystis colonization has been implicated as a cofactor in studies of chronic obstructive lung disease.7 In addition, Pneumocystis disease and colonization among patients with AIDS have been associated with airway dysfunction.8 In animal models, Pneumocystis colonization has been shown to promote many of the pathologic perturbations associated with asthma including increased TH2 inflammation, increased mucus production, and airway remodeling. [...]patients were required to meet at least 2 of the following minor criteria: (1) use of an additional controller medication to maintain asthma control, (2) use of short-acting bronchodilators at least 5 of 7 days of the week, (3) baseline FEV1 value of less than 80% predicted, (4) 1 or more urgent care visits in the previous year, (5) 3 or more oral corticosteroid bursts in the previous year, (6) a history of prompt deterioration in asthma symptoms with any reduction in corticosteroid therapy, or (7) history of a near-fatal asthma event requiring intubation. Characteristic SA (n = 15) non-A (n = 11) CF (n = 5) P value Age (y)∗ .0003 Mean ± SD 11.1 ± 4.5 5.2 ± 4.1 14.4 ± 2.7 Sex Male 11 (73.3) 6 (54.6) 3 (60) .6060† Fungal culture positive 1 (6.7) 0 (0) 1 (20) .4194† Bacterial culture positive 3 (20) 3 (27.3) 4 (80) .0589† BAL EOS > 1.19 % 6 (42.9)‡ 2 (18.2) 1 (20) .4340† BAL PMN > 3.5 % 6 (42.9)‡ 9 (81.8) 5 (100) .0401† 1 A.M. Fitzpatrick, W.G. Teague, Pediatr Allergy Immunol Pulmonol, Vol. 23, 2010, 131-138 2 D.L. Goldman, G.B. Huffnagle, Potential contribution of fungal infection and colonization to the development of allergy, Med Mycol, Vol. 47, 2009, 445-456 3 Y.J. Huang, The respiratory microbiome and innate immunity in asthma, Curr Opin Pulm Med, Vol. 21, 2015, 27-32 4 Q. Zhang, M. Cox, Z. Liang, F. Brinkmann, P.A. Cardenas, R. Duff, Airway microbiota in severe asthma and relationship to asthma severity and phenotypes, PLoS One, Vol. 11, 2016, e0152724 5 J. Durack, S.V. Lynch, S. Nariya,