-
[show abstract]
[hide abstract]
ABSTRACT: Although studies examining the serum suggest a role for eosinophils in wheezing episodes in infants and toddlers, the presence of a chronic eosinophilic inflammation within their airways remains to be demonstrated. In this study we investigated whether eosinophil cationic protein (ECP) levels are increased in BAL fluid (BALF) from infants and toddlers with recurrent wheezing episodes, during an asymptomatic period. The levels of ECP in BALF were quantitated by radioimmunoassay in 61 children (36 with severe recurrent episodes of wheezing and 25 who were non-wheezy), aged 6-36 months, in whom flexible bronchoscopy was clinically indicated. BALF eosinophil counts were < or = 1% in all patients and did not differ in wheezers, compared to non-wheezers. In contrast, ECP levels in BALF were > or = 2.2 micrograms/l in 18 of 36 (50%) wheezy infants but in only three of 25 (12%) control infants (p < 0.01). Neutrophil counts were significantly higher in the wheezer group than in the non-wheezer group (8.1 x 10(3) cells/ml vs. 3.0 x 10(3) cells/ml). ECP levels in the BALF were not correlated with the absolute number of eosinophils (r = 0.03; p = 0.8) but were correlated with the absolute number of neutrophils (r = 0.54; p = 0.001). There was no association between high ECP levels in BALF and the atopic status of the wheezers. In conclusion, ECP levels are increased in BALF from young children with recurrent wheezing episodes, even during relatively quiescent periods, suggesting a chronic increased cell activation in the lower airways.
Pediatric Allergy and Immunology 04/2001; 12(2):65-72. · 2.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We determined if alveolar macrophages (AMs) from infants with severe recurrent wheezing episodes release increased amounts of tumour necrosis factor-alpha (TNF-alpha), as described in adults with asthma. We compared TNF-alpha release by unstimulated and lipopolysaccharide-stimulated AMs obtained by bronchoalveolar lavage in 13 wheezy and seven nonwheezy infants (aged 6-36 months) and analysed its regulation by dexamethasone. Metabolites in cell supernatants were quantified by enzyme-linked immunosorbent assay (ELISA) (TNF-alpha) or radioimmunoassay (thromboxane B2 and prostaglandin E2). Comparison of results was performed by the Mann-Whitney U-test and values were expressed as median (interquartile range) in ng x 10(6) cells(-1). Resting AMs from wheezy infants released larger amounts of TNF-alpha and thromboxane B2 as compared to controls: 2.67 (0.89-8.33) vs 0.48 (0.25-1.08) and 75.63 (38.07-158.91) vs 10.03 (7.36-76.08), respectively (p<0.05). When stimulated overnight with bacterial lipopolysaccharide, AMs from both groups released similar amounts of metabolites. Dexamethasone induced a consistent inhibition of the lipopolysaccharide-stimulated release of all the mediators. Our results show that alveolar macrophages from wheezy infants are activated to release increased amounts of tumour necrosis factor-alpha, as in asthma, and suggest that infants with recurrent wheezing may eventually benefit from treatment with glucocorticoids.
European Respiratory Journal 09/1997; 10(8):1767-73. · 5.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To test the hypothesis that alveolar macrophages (AM) from wheezy infants release increased amounts of eicosanoids, as do AM from adults with asthma, we compared eicosanoid release by unstimulated- and ionophore-A23187-stimulated AM from 13 wheezy and six nonwheezy infants and analyzed its regulation by dexamethasone in vitro. Alveolar macrophages from wheezy infants released greater amounts of thromboxane A2 (TxA2) and leukotriene B4 (LTB4) under resting conditions and of TxA2 upon stimulation than did those from control subjects. Dexamethasone induced a dose-dependent inhibition of the spontaneous and A23187-stimulated release of TxA2, but not of the A23187-stimulated release of lipoxygenase products. The inhibition of TxA2 formation was maintained when free arachidonic acid was added during A23187 stimulation, demonstrating that dexamethasone acted mainly at a postphospholipase A2 site. AM exposed to acetylsalicylate and then incubated overnight exhibited de novo cyclooxygenase synthesis, suggesting the presence of the inducible cyclooxygenase as a target for inhibition by dexamethasone. In conclusion, our findings suggest that AM from wheezy infants are activated in vivo to release eicosanoids, as are AM from asthmatic adults, and they support the therapeutic indications of glucocorticoids in severe recurrent wheezing of infancy.
American Journal of Respiratory and Critical Care Medicine 11/1995; 152(4 Pt 1):1208-14. · 11.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Epidemiologic studies suggest an association between recurrent bronchiolitis in children younger than 3 years of age and diagnosis of asthma later in life. Bronchoalveolar lavages from 20 infants with recurrent wheezing and 18 nonwheezy control subjects were analyzed to determine whether alveolar macrophages of wheezy infants present abnormalities similar to those described in adults with asthma. Alveolar macrophages from both groups responded in vitro, in a concentration-dependent manner, to prostaglandin E2, salbutamol, and forskolin, drugs that increase cyclic adenosine monophosphate levels. However, alveolar macrophages from infants with recurrent wheezing accumulated less cyclic adenosine monophosphate than those from control subjects in response to all three stimulations. These results are in agreement with the reduced cyclic adenosine monophosphate response to different agonists demonstrated in leukocytes from patients with asthma, and suggest that this refractoriness could be one of the precipitating events in the development of asthma observed in a large proportion of infants who have had bronchiolitis.
Journal of Allergy and Clinical Immunology 06/1994; 93(5):885-90. · 11.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The value of 121 flexible bronchoscopy (FB) procedures was evaluated in 54 children, aged three months to 14 years, suspected of having pulmonary tuberculosis. Specimens from FB were culture-positive for Mycobacterium tuberculosis in seven of the 13 bacteriologically confirmed cases. Bronchial abnormalities consistent with the diagnosis were found in 31 of 54 cases. Separate or coexistent findings at initial FB included airway compression (20 cases), granulation tissue (ten cases), and obstructive caseum (four cases). Chest roentgenograms underestimated bronchial involvement in 14 children. Further FB monitoring documented disease evolution. The FB was important in the management of patients, as it (1) guided the use of prednisone therapy, especially in the children with a chest roentgenogram not suggestive of bronchial involvement; (2) indicated a need for resection of granulation tissue by rigid bronchoscopy (three cases); and (3) guided the surgical decision (two children with persistent bronchial obstruction). Thus, FB is a safe and valuable procedure in the management of childhood pulmonary tuberculosis.
Chest 10/1991; 100(3):688-92. · 5.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The retrospective analysis of 59 pediatric cases of pleural effusion showed that infectious agents account for 80% of cases. Thoracentesis proved to be the first-line diagnostic tool. Pleural biopsy was diagnostic in four tuberculous and two malignant pleural effusions. The literature data shows that pleural fluid total protein, lactate deshydrogenase, glucose, pH, white blood cell count and differential should be obtained in all patients. Because of the high incidence of infection, microbiologic studies are also indicated in children. These studies are of great value in distinguishing transudates from exsudates and in deciding on pleural drainage.
Pédiatrie 02/1990; 45(11):807-12.
-
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 7(5):346-7. · 2.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Among 31 children with an abnormal vascular arch, 13 had been referred for asthma: 7 infants and 6 older children with allergies. Respiratory symptomatology, not specific to anomaly, was special in terms of its chronicity and, in older children, the sudden onset of attacks. Esophageal barium studies and bronchial fibroscopy revealed 9 retro-esophageal subclavian arteries, 2 double aortic arches, one Neuhauser anomaly and one mirror image right aortic arch. In the latter two cases, chest X-ray showed lateral deviation of the tracheal axis. It was difficult to distinguish between symptomatology linked to the arch and that due to asthma, and hence to decide whether surgery was indicated for subclavian arteries (4/9). Following section/suture of the artery, attacks became less frequent and above all lost their sudden nature. In the infant, asthma remains a diagnosis of exclusion and an aortic arch anomaly should be sought routinely, as should tracheal dyskinesia or mucoviscidosis. Investigation of the aortic arches has benefited from technical advances in endoscopy and new radiological imaging methods with magnetic resonance imaging, which has shown itself to be of great value when determining the indications for surgery.
Revue Française d'Allergologie et d'Immunologie Clinique.
-
[show abstract]
[hide abstract]
ABSTRACT: Between 1986 and 1992, 324 bronchial fibroscopies under local anesthesia were performed in infants less than 2 years of age, because of recurrent dyspneic bronchitis (279 cases) or persistent wheezing (45 cases). Morphological abnormalities were found in 27 per cent of cases. This involved tracheal and/or bronchial dyskinesia in 19 per cent of cases. An anatomical abnormality was present in 11 per cent of cases: flattening (3 per cent), compression (3 per cent) inflammatory or congenital stenosis (3 per cent), foreign body (2 per cent). The incidence of abnormalities was significantly greater in infants with persistent wheezing (40 v. 25 per cent, p < 0.05). Although this was a retrospective study, the incidence of abnormalities found justifies the inclusion of endoscopic investigation in the evaluation of severe recurrent dyspneic bronchitis and of persistent wheezing in infants.
Revue Française d'Allergologie et d'Immunologie Clinique.
