Abstract
Rationale Wheeze at preschool age includes different disease entities. It has been proposed that episodic wheeze (only with viral infections) and multitrigger wheeze may represent distinct phenotypes.
Aim To define clinical and pathological features typical of children with episodic or multitrigger wheeze at preschool age.
Methods We studied 55 children undergoing bronchoscopy for clinical indications:11 with episodic wheeze (4;1-6 yrs), 24 with multitrigger wheeze (4;1-6) and 20 controls (4;2-6). Structural and inflammatory changes were assessed in bronchial biopsies by histochemistry and immunohistochemistry.
Results Age at onset (1.2;0.5-4 vs 1;0-3.5yrs) and symptom duration (3;1-3.5 vs 2.5;1-6yrs) were similar in children with episodic and multitrigger wheeze. Prevalence of atopy (45%vs 40%) and number of infectious episodes (mean:1/month) were similar in the 2 groups. Children with episodic and those with multitrigger wheeze had similar airway pathology with higher numbers of mast cells (461;100-800 and 441;113-95/mm2) and eosinophils (50;0-586 and 63;0-267/mm2) compared to controls (143;8-650/mm2,p=0.0005 and 9,0-200/mm2,p=0.01). Epithelial loss and BM thickness were also increased in episodic and multitrigger wheezers and correlated with mast cell count (r=0.36,p<0.01 and r=0.40,p<0.01). Pathological and clinical features were not dependent on age or atopic status.
Conclusion Children with episodic wheeze at preschool age are indistinguishable from those with multitrigger wheeze in pattern of symptom onset and duration, prevalence of atopy and airway pathology. This suggests that episodic and multitrigger wheezers represent the same disease with different attack predisposition.
- © 2014 ERS