Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Summary Background It seems plausible that children with atopy and persistent asthma symptoms will, like their adult counterparts, have chronic airways inflammation. However, many young children with no other atopic features have episodic wheezing that is triggered solely by viral respiratory infections. Little is known as to whether airways inflammation occurs in these two asthma patterns during relatively asymptomatic periods. Methods Using a non‐bronchoscopic bronchoalveolar lavage (BAL) procedure on children presenting for an elective surgical procedure, this study has investigated the cellular constituents of BAL fluid in children with a history of atopic asthma (AA) non‐asthmatic atopic children (NAA) or viral associated wheeze (VAW). Results A total of 95 children was studied: 52 with atopic asthma (8.0 years, range 1.1–15.3, 36 male), 23 with non‐asthmatic atopy (median age 8.3 years, range 1.7–13.6, 11 male) and 20 with VAW (3.1 years, range 1.0–8.2, 13 male). No complications were observed during the lavage procedure and no adverse events were noted post‐operatively. Total lavage fluid recovered was similar in all groups and the total cell numbers were higher in the VAW group. Eosinophil (P≤ 0.005) and mast cell (P≤ 0.05) numbers were significantly elevated in the group with atopic asthma. Conclusions During relatively asymptomatic periods there is on‐going airways inflammation, as demonstrated by eosinophil and mast cell recruitment, in children with asthma and atopy but not in children with viral associated wheeze or atopy alone. This strongly suggests that there are different underlying pathophysiological mechanisms in these two groups of children who wheeze.