1. Bronchial Remodeling-based Latent Class Analysis Predicts Exacerbations in Severe Preschool Wheezers
- Author
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Michael Fayon, Fabien Beaufils, Pauline Esteves, Maryline Campagnac, Elise Maurat, Marine Michelet, Valerie Siao-Him-Fa, Frederic Lavrand, Guillaume Simon, Hugues Begueret, Patrick Berger, Françoise Auriol, Sylvain Blanchon, Dominique Carles, Vincent Boisserie-Lacroix, François Brémont, Stéphanie Bui, Marie-Luce Choukroun, Stéphane Debelleix, Hala Feghali, Géraldine Labouret, Audrey Martin Blondel, Sébastien Marais, Marie Mittaine, Fabienne Nacka, Olga Ousova, Isabelle Rouquette, François Semjen, Frédérique Sgoifo, and Thomas Trian
- Subjects
Pulmonary and Respiratory Medicine ,Critical Care and Intensive Care Medicine - Abstract
Children with preschool wheezing represent a very heterogeneous population with wide variability regarding their clinical, inflammatory, obstructive, and/or remodeling patterns. We hypothesized that assessing bronchial remodeling would help clinicians to better characterize severe preschool wheezers.The main objective was to identify bronchial remodeling-based latent classes of severe preschool wheezers. Secondary objectives were to compare cross-sectional and longitudinal clinical and biological data between classes, and to assess the safety of bronchoscopy.This double-center prospective study (NCT02806466) included severe preschool wheezers (1-5 years old), requiring fiberoptic bronchoscopy. Bronchial remodeling parameters (i.e., epithelial integrity, reticular basement membrane (RBM) thickness, mucus gland, fibrosis and bronchial smooth muscle (BSM) areas, density of blood vessels, and RBM-BSM distance) were assessed and evaluated by Latent Class Analysis. An independent cohort of severe preschool wheezers (NCT04558671) was used to validate our results.Fiberoptic bronchoscopy procedures were well tolerated. A two-class model was identified: Class BR1 was characterized by increased RBM thickness, normalized BSM area, density of blood vessels, and decreased mucus gland area, fibrosis and RBM-BSM distance compared to Class BR2. No significant differences were found between classes in the year prior to fiberoptic bronchoscopy. By contrast, Class BR1 was associated with a shorter time to first exacerbation and an increased risk of both frequent (3) and severe exacerbations during the year following bronchoscopy in the two cohorts.Assessing bronchial remodeling identified severe preschool wheezers at risk of frequent and severe subsequent exacerbations with a favorable benefit to risk ratio.
- Published
- 2023