The relationship between inflammation and remodeling in childhood asthma: A systematic review

Autor: Louis Fleming, Carlos E. Rodriguez-Martinez, María Angélica Oyarzún, Jose A. Castro-Rodriguez, Andrew Bush, Sejal Saglani
Přispěvatelé: Asthma UK, British Medical Association, Royal Brompton & Harefield NHS Foundation Trust, Wilhelm Doerenkamp-Stiftung Chur, National Institute for Health Research, Wellcome Trust
Rok vydání: 2017
Předmět:
0301 basic medicine
Respiratory System
bronchial biopsy
airway inflammation
Pediatrics
Remodelación de las vías aéreas (Respiratorias)
0302 clinical medicine
Bronchoscopy
AIRWAY SMOOTH-MUSCLE
airway biopsy
Eosinophilic
1114 Paediatrics And Reproductive Medicine
bronchoalveolar lavage
Eosinophilia
Child
Children
Eosinophil cationic protein
medicine.diagnostic_test
infants
DIFFICULT ASTHMA
Airway remodeling
respiratory system
LUNG-FUNCTION
ATOPIC ASTHMA
EOSINOPHIL CATIONIC PROTEIN
Airway Remodeling
medicine.symptom
Life Sciences & Biomedicine
Infants
PRESCHOOL WHEEZERS
Airway inflammation
Pulmonary and Respiratory Medicine
Bronchoalveolar lavage
YOUNG-CHILDREN
medicine.medical_specialty
Inflammation
03 medical and health sciences
children
Bronchial biopsy
Internal medicine
Airway biopsy
medicine
ALLERGEN CHALLENGE
Humans
Asthma
Science & Technology
Wheezing
wheezing
business.industry
Lavado broncoalveolar
medicine.disease
respiratory tract diseases
Estado asmático
030104 developmental biology
030228 respiratory system
Pediatrics
Perinatology and Child Health
PEDIATRIC SEVERE ASTHMA
RETICULAR BASEMENT-MEMBRANE
Airway
business
Zdroj: Repositorio U. El Bosque
Universidad El Bosque
instacron:Universidad El Bosque
ISSN: 1099-0496
Popis: 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 pre-school 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 school-age children. RBM thickness was similar in atopic and non-atopic preschool wheezers. Airway remodeling was correlated with lung function in seven studies, with FeNO in three, and with HRCT-scan 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, non-invasive markers of remodeling in particular if this is to be addressed.
Databáze: OpenAIRE
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