cogitation objective: To determine the confined apartment profile of BAL from infants with rigid recurrent wheezing who were not acutely ill at the time of investigation.

cogitation objective: To determine the confined apartment profile of BAL from infants with rigid recurrent wheezing who were not acutely ill at the time of investigation, suggesting an ongoing inflammation.

Design and patients: In a retrospective consideration we determined BAL cell profiles for 83 children with wheezing aged 4 to 32 month (mean [+ or -] SD 113 [+ or -] 55 months) Fiberoptic bronchoscopy was performed in children with plain recurrent wheezy bronchitis unresponsive to inhaled steroids. These children were compared with 17 children aged 6 to 36 month (mean, 151 [+ or -] 75 months) with various nonwheezing pulmonary diseases. Children were included as superintend subjects if they had no endobronchial inflammation and no atopy.

Results: The BAL solitary abode; squalid profile of young children with wheezing typically includes a significantly higher small cavity count (mean, 644.4 [+ or -] 9568 x [10sup3]/mL v 313 [+ or -] 2032 x [10sup3]/mL p = 0008) a significantly higher percentage of neutrophils (mean, 9 [+ or -] 121% v 21 [+ or -] 22% p = 0003) and a higher neutrophil cast (mean, 43.2 [+ or -] 816 x [10sup3]/mL v 79 [+ or -] 118 x [10sup3]/mL p = 0003) as compared with reign over subjects. The larger number of neutrophils in children with wheezing was not correlated with bacterial or viral infection, or with age, sex or atopic status. In contrast to the situation in asthmatic adults, eosinophil evens were not higher in children with wheezing than in mastery subjects (mean, 0.09 [+ or -] 027% v 008 [+ or -] 025%)

Conclusion: Neutrophil-mediated inflammation in the airways appears to better characterize inexorable recurrent wheezing in children < 3 years old

guide words: asthma; BAL; flexible bronchoscopy; infants; wheezing

Abbreviations: FB = flexible bronchoscopy; RSV = respiratory syncytial virus

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renewed episodes of wheezing are highly heterogeneous and a major cause of morbidity in young children. The clinical manifestations of returning wheezing in infants resemble those of asthma. Progression is variable in these infants: a certain quantity of will have only transient wheezing associated with returning respiratory viral infections, whereas others will have persistent asthma. Maternal asthma, atopy, and male sex seem to predispose the infant to late-onset persistent wheezing. (1) The physiopathology of returning episodes of wheezing in young children is unclear, however persistent bronchial inflammation may play an essential character Consistent with this, inhaled corticosteroids have been shown to be effective, improving symptoms and decreasing the ne for oral corticosteroids. (2-5) In these true young children, bronchial inflammation appear to bes to be characterized by a high of the same height of neutrophils in BAL. (67) Azevedo et al (89) demonstrated the involvement of macrophage activation in the BAL of infants with wheezing. This activation inferences in the excessive production of proinflammatory metabolites, in the same state [i]or[/i] condition as tumor necrosis factor-[alpha], (8) and eicosanoids, as it is as thromboxane [B.sub.2] and leukotriene [Bsub4] (9) which are involved in the chemoattraction of neutrophils. (10) The aim of this thought was to determine the confined apartment profile of BAL from infants with accurate recurrent wheezing far from an acute exacerbation, to confirm an increase in neutrophil evens in the BAL suggesting an ongoing inflammation, and to evaluate its relationship to various factors: infection, atopy, and age.

MATERIALS AND METHODS

Demographic and clinical data were obtained on retrospective review of the patients' medical records.

Children With Wheezing

All of the children < 36 month of age who underwent flexible bronchoscopy (FB) with BAL for accurate recurrent wheezing (at least three moderate-to-severe episodes) were retrospectively identified from a bronchoscopy database between January 1993 and December 1999 strict recurrent wheezing attested by of common occurrence exacerbations requiring oral corticosteroids more than formerly a month, persistent chronic symptoms in between with poor rejoinder to inhaled bronchodilators, and a trial of at least 6 weeks of inhaled corticosteroids l to an investigation of airway abnormalities by dint of FB. Eighty-three children with wheezing were retrospectively included (age range, 4 to 32 months; mean [+ or -] SD 113 [+ or -] 55 months) 58 of whom were male (70%) about of these children have been included in previous studies. (8911) FB was performed at least 15 days after an acute exacerbation and at least 15 days after an eventual short course of oral steroids. None of the children were receiving antibiotics at the time of FB

Children with wheezing were classified as atopic if they had at least single of the following: a family history of atopy, atopic dermatitis diagnosed on a doctor, or positive skin trial findings for common allergens. Children were considered to have a family history of atopy if single in kind or both parents or any siblings had atopic diseases (allergic rhinitis, asthma, or atopic dermatitis). Allergy proofs were performed and interpreted as previously described. (1213) Atopic predisposition was investigated in 66 of the 83 children with wheezing, of whom 47 children (71%) were considered to have atopy.

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