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To the Editor: Preschool wheezing affects up to 50% of children [1, 2], of whom approximately half will have stopped experiencing wheezy episodes by the age of 6 yrs [2]. Results from large cohort studies [2, 3] raise several important questions. First, when facing a child with preschool wheeze, how can we predict the natural history and identify those children who are going to grow out of their asthma by mid-childhood and distinguish them from those who develop classical, adult-type asthma? Secondly, how can we identify those children who are likely to benefit from treatment with inhaled corticosteroids, leukotriene receptor antagonists or both, in the absence of reliable immunological criteria underpinning these decisions? Airway inflammation is a key feature of asthma and is detectable in preschool children [4]. Obtaining lower-airway samples from preschool children usually involves bronchoalveolar lavage sampling under general anaesthesia and is therefore reserved for children with problematic severe asthma or where the diagnosis is in doubt [4]. An alternative method of obtaining samples noninvasively from the lower airways is by sputum induction [5]. The use of induced sputum in infants has been limited [6–8] and inflammatory cell profiles have not been reported. Mussaffi et al. [6] performed the procedure in young children with cystic fibrosis and reported that the procedure was well tolerated, and there was a high success rate in nonexpectorating patients. Successful use of sputum induction in the diagnosis of tuberculosis was reported in 142 out of 149 infants with a median age of 9 months [ …

Background Epidemiological studies suggest that inhalation of carbonaceous particulate matter from biomass combustion increases susceptibility to bacterial pneumonia. In vitro studies report that phagocytosis of carbon black by alveolar macrophages (AM) impairs killing of Streptococcus pneumoniae. We have previously reported high levels of black carbon in AM from biomass smoke-exposed children and adults. We therefore aimed to use a mouse model to test the hypothesis that high levels of carbon loading of AM in vivo increases susceptibility to pneumococcal pneumonia. Methods Female outbred mice were treated with either intranasal phosphate buffered saline (PBS) or ultrafine carbon black (UF-CB in PBS; 500 μg on day 1 and day 4), and then infected with S. pneumoniae strain D39 on day 5. Survival was assessed over 72 h. The effect of UF-CB on AM carbon loading, airway inflammation, and a urinary marker of pulmonary oxidative stress was assessed in uninfected animals. Results Instillation of UF-CB in mice resulted a pattern of AM carbon loading similar to that of biomass-smoke exposed humans. In uninfected animals, UF-CB treated animals had increased urinary 8-oxodG (P = 0.055), and an increased airway neutrophil differential count (P < 0.01). All PBS-treated mice died within 72 h after infection with S. pneumoniae, whereas morbidity and mortality after infection was reduced in UF-CB treated animals (median survival 48 h vs. 30 h, P < 0.001). At 24 hr post-infection, UF-CB treated mice had lower lung and the blood S. pneumoniae colony forming unit counts, and lower airway levels of keratinocyte-derived chemokine/growth-related oncogene (KC/GRO), and interferon gamma. Conclusion Acute high level loading of AM with ultrafine carbon black particles per se does not increase the susceptibility of mice to pneumococcal infection in vivo.

Hyperoxia is closely linked with the development of chronic lung disease of prematurity (CLD), but the exact mechanisms whereby hyperoxia alters the lung architecture in the developing lung remain largely unknown. We developed a fetal human lung organ culture model to investigate (a) the morphologic changes induced by hyperoxia and (b) whether hyperoxia resulted in differential cellular responses in the epithelium and interstitium. The effects of hyperoxia on lung morphometry were analyzed using computer-assisted image analysis. The lung architecture remained largely unchanged in normoxia lasting as long as 4 d. In contrast, hyperoxic culture of pseudoglandular fetal lungs resulted in significant dilatation of airways, thinning of the epithelium, and regression of the interstitium including the pulmonary vasculature. Although there were no significant differences in Ki67 between normoxic and hyperoxic lungs, activated caspase-3 was significantly increased in interstitial cells, but not epithelial cells, under hyperoxic conditions. These changes show that exposure of pseudoglandular lungs to hyperoxia modulates the lung architecture to resemble saccular lungs.