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Airway Inflammation in Childhood Asthma

Department of Pediatrics; Department of Clinical and Experimental Medicine, Section of Respiratory Diseases; Department of Respiratory Diseases and Radiology, University of Modena and Reggio Emilia; Institute of Pathology; and Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy

Correspondence and requests for reprints should be addressed to Marina Saetta, M.D., Divisione di Pneumologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Padova, via Giustiniani 3, 35128 Padua, Italy. E-mail: marina.saetta{at}unipd.it

Airway pathology has been extensively investigated in adulthood asthma, whereas only few studies examined bronchial biopsies in childhood asthma. To evaluate the airway pathology in children with asthma, we analyzed bronchial biopsies obtained from 23 children undergoing bronchoscopy for clinical indications other than asthma. Nine had mild/moderate asthma. Six had atopy without asthma, and eight had no atopy or asthma. We measured basement membrane thickness and quantified the number of eosinophils, mast cells, neutrophils, macrophages, T lymphocytes, and positive cells for transforming growth factor-ß1 (TGF-ß1) and its receptors I and II (TGFß-RI and TGFß-RII) in subepithelium. Children with asthma had an increase in basement membrane thickness and in the number of eosinophils compared with control subjects, but not compared with children with atopy. They also had a decreased expression of TGFß-RII compared with both those with atopy and control subjects. In children with asthma, the number of eosinophils correlated negatively with TGFß-RII and positively with symptom duration. In conclusion, airway eosinophilia and basement membrane thickening, which are the pathologic features that are characteristic of adulthood asthma, are already present in children with mild asthma, and even in children with atopy without asthma. Moreover, in children with asthma but not in children with atopy without asthma, there is a downregulation of TGFß-RII.

Key Words: inflammation • remodeling • pediatric asthma • cytokines

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