The relationship between inflammation and remodeling in childhood asthma: A systematic review
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Fecha
2018
TĂtulo de la revista
Publicado en
Pediatric pulmonology, 1099-0496, Vol 53, Num 6, 2018, pag 824-835
Publicado por
Wiley
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Resumen
DescripciĂłn
Abstract
Objectives
We aimed to perform a systematic review of all studies with direct measurements of both airway inflammation and remodeling in the subgroup of children with repeated wheezing and/or persistent asthma severe enough to warrant bronchoscopy, to address whether airway inflammation precedes remodeling or is a parallel process, and also to assess the impact of remodeling on lung function.
Methods
Four databases were searched up to June 2017. Two independent reviewers screened the literature and extracted relevant data.
Results
We found 526 references, and 39 studies (2390 children under 18 years old) were included. Airway inflammation (eosinophilic/neutrophilic) and remodeling were not present in wheezers at a mean age of 12 months, but in older preâschool children (mean 2.5 years), remodeling (mainly increased reticular basement membrane [RBM] thickness and increased area of airway smooth muscle) and also airway eosinophilia was reported. This was worse in schoolâage children. RBM thickness was similar in atopic and nonâatopic preschool wheezers. Airway remodeling was correlated with lung function in seven studies, with FeNO in three, and with HRCTâscan in one. Eosinophilic inflammation was not seen in patients without remodeling. There were no invasive longitudinal or intervention studies.
Conclusion
The relationship between inflammation and remodeling in children cannot be determined. Failure to demonstrate eosinophilic inflammation in the absence of remodeling is contrary to the hypothesis that inflammation causes these changes. We need reliable, nonâinvasive markers of remodeling in particular if this is to be addressed.
Palabras clave
Keywords
Airway biopsy, Airway inflammation, Airway remodeling, Asthma, Bronchial biopsy, Bronchoalveolar lavage, Children, Infants, Wheezing
TemĂĄticas
Estado asmĂĄtico
RemodelaciĂłn de las vĂas aĂŠreas (Respiratorias)
Lavado broncoalveolar
RemodelaciĂłn de las vĂas aĂŠreas (Respiratorias)
Lavado broncoalveolar