Bronchoalveolar cell profiles in children with asthma, infantile wheeze, chronic cough, or cystic fibrosis

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.