C. Marguet et al., Bronchoalveolar cell profiles in children with asthma, infantile wheeze, chronic cough, or cystic fibrosis, AM J R CRIT, 159(5), 1999, pp. 1533-1540
Differential cell counts of bronchoalveolar ravage (BAL) have been reported
in normal children but few data on cellular profiles in bronchial diseases
in childhood are available. We determined the BAL cell profiles of 72 chil
dren divided into 5 groups: asthma (n = 14), chronic cough (n = 12), infant
ile wheeze (n = 26), cystic fibrosis (n = 10), and control (n = 10). The hi
ghest total cell, eosinophil, and neutrophil counts were found in children
with cystic fibrosis. The cell profile of children with chronic cough was s
imilar to that of control children. Asthma and infantile wheeze were charac
terized by a high median ratio of eosinophils (3%) and neutrophils (12%), r
espectively, in both diseases, epithelial shedding was suggested by an elev
ated epithelial cell count, 13.5 and 12%, respectively. Lymphocyte subset a
nalysis showed a higher proportion of CD8 cells (58 versus 40%) and therefo
re a lower CD4/CD8 ratio (0.266 versus 0.455) in children with asthma compa
red with infantile wheezers (p = 0.02). Irrespective of the presence or abs
ence of radiological abnormalities, a proportion of neutrophils > 10%, was
found in one-third of the children with asthma and in half of the infantile
wheezers, and was related to symptom severity. We suggest that neutrophil-
mediated inflammation, with or without bacterial infection, may contribute
to symptoms of asthma in childhood. Chronic cough, however, is not associat
ed with the cell profiles suggestive of asthma and in isolation should not
be treated with prophylactic antiasthma drugs.