Benefits and risks of bronchoalveolar lavage in severe asthma in children.
Journal
ERJ open research
ISSN: 2312-0541
Titre abrégé: ERJ Open Res
Pays: England
ID NLM: 101671641
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
13
05
2021
accepted:
27
09
2021
entrez:
9
12
2021
pubmed:
10
12
2021
medline:
10
12
2021
Statut:
epublish
Résumé
Although bronchoscopy can be part of the exploration of severe asthma in children, the benefit of bronchoalveolar lavage (BAL) is unknown. The present study aimed to decipher whether systematic BAL during a flexible bronchoscopy procedure could better specify the characteristics of severe asthma and improve asthma management. The study took place in two departments of a university hospital in Paris. Children who underwent flexible bronchoscopy for the exploration of severe asthma between April 2017 and September 2019 were retrospectively included. In total, 203 children were included, among whom 107 had a BAL. BAL cell count was normal in most cases, with an increasing number of eosinophils with age, independently from the atopic status of the patients. Compared with bronchial aspiration only, BAL increased the rate of identified bacterial infection by 1.5. Nonatopic patients had more bacterial infections (p<0.001). BAL induced a therapeutic modification only for azithromycin and omalizumab prescriptions. The practice of a BAL decreased bronchoscopy tolerance (p=0.037), especially in the presence of tracheobronchial malacia (p<0.01) and when performed in a symptomatic patient (p=0.019). Although BAL may provide interesting information in characterising severe asthma, in most cases its impact on the patient's management remains limited. Moreover, BAL can be poorly tolerated and should be avoided in the case of tracheobronchial malacia or current asthma symptoms.
Sections du résumé
BACKGROUND
BACKGROUND
Although bronchoscopy can be part of the exploration of severe asthma in children, the benefit of bronchoalveolar lavage (BAL) is unknown. The present study aimed to decipher whether systematic BAL during a flexible bronchoscopy procedure could better specify the characteristics of severe asthma and improve asthma management.
MATERIAL AND METHODS
METHODS
The study took place in two departments of a university hospital in Paris. Children who underwent flexible bronchoscopy for the exploration of severe asthma between April 2017 and September 2019 were retrospectively included.
RESULTS
RESULTS
In total, 203 children were included, among whom 107 had a BAL. BAL cell count was normal in most cases, with an increasing number of eosinophils with age, independently from the atopic status of the patients. Compared with bronchial aspiration only, BAL increased the rate of identified bacterial infection by 1.5. Nonatopic patients had more bacterial infections (p<0.001). BAL induced a therapeutic modification only for azithromycin and omalizumab prescriptions. The practice of a BAL decreased bronchoscopy tolerance (p=0.037), especially in the presence of tracheobronchial malacia (p<0.01) and when performed in a symptomatic patient (p=0.019).
DISCUSSION AND CONCLUSION
CONCLUSIONS
Although BAL may provide interesting information in characterising severe asthma, in most cases its impact on the patient's management remains limited. Moreover, BAL can be poorly tolerated and should be avoided in the case of tracheobronchial malacia or current asthma symptoms.
Identifiants
pubmed: 34881325
doi: 10.1183/23120541.00332-2021
pii: 00332-2021
pmc: PMC8645873
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright ©The authors 2021.
Déclaration de conflit d'intérêts
Conflict of interest: R. Ben Tkhayat has nothing to disclose. Conflict of interest: J. Taytard has nothing to disclose. Conflict of interest: H. Corvol has nothing to disclose. Conflict of interest: L. Berdah has nothing to disclose. Conflict of interest: B. Prévost has nothing to disclose. Conflict of interest: J. Just has nothing to disclose. Conflict of interest: N. Nathan has nothing to disclose.
Références
J Allergy Clin Immunol. 2017 Jun;139(6):1819-1829.e11
pubmed: 27746241
Eur Respir J. 2000 Jan;15(1):217-31
pubmed: 10678650
Chest. 2002 Sep;122(3):791-7
pubmed: 12226015
Eur Respir Rev. 2015 Sep;24(137):474-83
pubmed: 26324809
J Asthma Allergy. 2020 Jan 30;13:67-75
pubmed: 32099412
Eur Respir J. 2014 Feb;43(2):343-73
pubmed: 24337046
Curr Opin Pulm Med. 2013 Jan;19(1):42-8
pubmed: 23197289
Chest. 1991 Mar;99(3):591-4
pubmed: 1995213
Am Rev Respir Dis. 1989 Dec;140(6):1527-37
pubmed: 2604284
J Pediatr. 2000 Oct;137(4):517-22
pubmed: 11035831
Clin Exp Allergy. 1997 Sep;27(9):1027-35
pubmed: 9678834
Pediatr Allergy Immunol. 2001 Apr;12(2):73-7
pubmed: 11338289
J Allergy Clin Immunol Pract. 2019 Jul - Aug;7(6):1803-1812.e10
pubmed: 30654199
J Allergy Clin Immunol. 2021 Feb;147(2):686-693.e3
pubmed: 32526308
Pediatr Pulmonol. 2003 Apr;35(4):302-8
pubmed: 12629629
Eur Respir J. 1993 Apr;6(4):489-97
pubmed: 8491298
J Pediatr. 1998 Feb;132(2):312-8
pubmed: 9506647
J Allergy Clin Immunol Pract. 2017 Sep - Oct;5(5):1351-1361.e2
pubmed: 28363401
J Asthma. 2020 Apr;57(4):366-372
pubmed: 30795692
Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1533-40
pubmed: 10228122
Pediatr Pulmonol. 2001 Feb;31(2):150-64
pubmed: 11180692
Chest. 1993 Oct;104(4):1032-7
pubmed: 8404161
Am J Respir Crit Care Med. 2015 May 1;191(9):1066-80
pubmed: 25932763
J Allergy Clin Immunol. 2002 Jul;110(1):42-4
pubmed: 12110817