Reviews and feature articleAlveolar macrophage phagocytosis is impaired in children with poorly controlled asthma
Section snippets
Sample
Children 5 to 17 years of age undergoing flexible bronchoscopy with bronchoalveolar lavage (BAL) for clinical indications were recruited from the outpatient pulmonary clinic at Emory University. Indications for bronchoscopy included (1) poor asthma control despite maximum ICS doses, (2) suspected aspiration, (3) suspected atypical infection, or (4) confirmation of habitual cough or vocal cord dysfunction. This study was approved by the Emory University Institutional Review Board. Informed
Results
Thirty-four children with poorly controlled asthma (severe asthma, n = 18) were recruited for the study. Four children (severe asthma, n = 2) had BAL fluid colonization with Streptococcus pneumoniae, Moraxella catarrhalis, or both and were excluded from data analyses. Ten children with chronic cough treated with ICSs served as control subjects. All children in this group had been receiving ICSs for at least 16 weeks before bronchoscopy (median, 30 weeks; range, 16-52 weeks). Postbronchoscopy
Discussion
This is the first study to demonstrate impairment of AM phagocytosis in children with poorly controlled asthma. In subjects with moderate and severe asthma, phagocytosis was decreased by more than 50% compared with that seen in adult and pediatric control subjects. AM apoptosis was also greater in asthmatic subjects and increased further with LPS stimulation. These data suggest that the airway innate immune response might be impaired in children with poorly controlled asthma, a finding that
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Supported with funds from National Institutes of Health (NIH)/National Institute of Nursing Research KO1 NR010548, NIH/National Center for Research Resources K12 RR017643 and KL2 RR025009, and NIH/National Heart, Lung, and Blood Institute SARP RO1 HL69170.
Disclosure of potential conflict of interest: W. G. Teague is on the speakers' bureau for Merck. The rest of the authors have declared that they have no conflict of interest.