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Wheeze is a common symptom in infants, but not all wheezers develop asthma. Indeed, up to 50% of wheezing children outgrow their symptoms by school age. How to predict if early wheeze will become asthma is still a matter of vivid debate. In this work, we sought to assess the clinical and pathological factors that might predict the future development of asthma in children. Eighty children (mean age 3.8 ± 1 yr) who underwent a clinically indicated bronchoscopy were followed prospectively for a median of 5 years. At baseline, clinical characteristics with a particular focus on wheezing and its presentation (episodic or multitrigger) were collected, and structural and inflammatory changes were quantified in bronchial biopsies. Follow-up data were available for 74 of the 80 children. Children who presented with multitrigger wheeze were more likely to have asthma at follow-up than those with episodic wheeze (P = 0.04) or without wheeze (P < 0.0001). Children with asthma also had lower birth weights (P = 0.02), a lower prevalence of breastfeeding (P = 0.02), and a trend for increased IgE (P = 0.07) at baseline than those with no asthma. Basement membrane thickness and airway eosinophils at baseline were increased in children who developed asthma at follow-up (P = 0.001 and P = 0.026, respectively). Multivariate analysis showed that among all clinical and pathological factors, multitrigger wheezing, basement membrane thickening, and reduced birth weight were predictive of future asthma development. We conclude that multitrigger wheeze and reduced birth weight are clinical predictors of asthma development. Basement membrane thickening in early childhood is closely associated with asthma development, highlighting the importance of airway remodeling in early life as a risk factor for future asthma. [ABSTRACT FROM AUTHOR]

Summary: Background: The influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood. Objective: To assess their association with asthma symptoms and lung function at school age. Methods: Preschoolers (38.4 months) initially investigated with bronchial biopsies were re‐assessed for asthma symptoms and lung function at school age. Results: Thirty‐six of 49 preschoolers (73.5%) were assessed at 10.9 years. Twenty‐six (72.2%) had persistent asthma. Submucosal eosinophil counts were higher in children with severe exacerbations at school age than in those without (16/0.1 mm2 [11.2‐30.4] vs 8/0.1 mm2 [2.4‐17.6], P = .02), and correlated with the number of severe exacerbations (P = .04, r = .35). Submucosal neutrophil counts correlated with FEV1/FVC (P < .01, r = .47) and FEF25‐75% predicted (P = .02, r = .43). Airway smooth muscle (ASM) area correlated with FEV1/FVC (P < .01, r = .51). Vessel numbers negatively correlated with FEV1% predicted and FEV1/FVC (P = .03, r = −.42; P = .04, r = −.41; respectively) and FEF25‐75% predicted (P = .02, r = −.46). Conclusion: Eosinophilic inflammation in preschoolers with severe recurrent wheeze might be predictive of future severe exacerbations, neutrophilia might be associated with better lung function. Changes in ASM and vascularity might affect lung function at school age. [ABSTRACT FROM AUTHOR]

Aims of this study were to define (1) whether toluene diisocyanate (TDI) bronchial hyper-responsiveness persists in subjects with occupational asthma after long-term cessation of exposure; (2) whether evolution of specific bronchial TDI sensitization and symptoms and functional abnormalities of asthma were coincident, and (3) the determinants at the time of diagnosis of patients’ outcome. Twenty-five nonatopic spray painters with occupational asthma due to TDI were re-examined 58 ± 7 (46–73) months after removal from exposure. On both examinations, the severity of asthmatic symptoms and the need for antiasthma treatment over the past 12 months were graded and lung function tests, measurement of airway responsiveness to methacholine (PD20), circulating total IgE and TDI-HSA specific IgE, skin tests with common inhalant allergens and specific bronchial challenge with TDI were carried out. Seven subjects were still TDI-reactors and 18 lost reactivity to it. All persistent reactors had still asthma and their symptom score, medication score, FEV1, PD20 and serum IgE were unchanged between assessments. In the 18 subjects no longer responsive to TDI, 8 had still features of asthma: their symptom and medication score had improved significantly, but FEV1, PD20 and serum IgE had not significantly changed; the other ten patients no longer reactors to TDI were also asymptomatic and their PD20 had become normal. The duration of symptomatic exposure to TDI was the only feature at diagnosis that differentiated patients with persistent TDI airway hyper-responsiveness and asthma from those who were no longer responsive to TDI but still asthmatic and those who were no longer responsive to TDI and no longer asthmatic (4 ± 1. 6; 2. 1 ± 0. 8; 0. 6 ± 0. 3 years, respectively; p < 0. 001). Our study demonstrates that airway sensitization to TDI and symptoms and functional airway abnormalities of asthma can persist for years after cessation of exposure and may have different outcome. If avoidance of the offending agent takes place within few months after the development of symptoms, remission of asthma and of TDI bronchial hyper-responsiveness can occur, whereas waiting for years makes it too late to cure asthma and, in the end, to reverse specific sensitization. [ABSTRACT FROM AUTHOR]

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Abstract: The median-term clinical course and the evolution of pulmonary function in asthmatic infants is still not well known. The present report describes the results of a prospective study of 129 asthmatic infants who were first seen at an average age of 16±1 months. The infants were re-evaluated when they had reached 5, 7 and 9 years of age; 80 (62%) were available for the final evaluation. At 5 years of age, 19% of the children no longer had episodes of wheezing. On the other hand, at 9 years of age 49% continued to have asthma regularly. There was a close association between the symptoms reported at 5 years of age and the patient''s status at 9 years of age: it was mainly the children who were asymptomatic when seen at 5 years who subsequently had no asthmatic attacks between 5 and 9 years, whereas the large majority (79%) of those who wheezed at 5 years also wheezed at 9 years of age. The clinical course between inclusion and the 5th year follow-up visit was closely correlated with the subsequent evolution of the children''s pulmonary function: for those who were still asthmatic at 5 years of age, the FEV1, FEV1/FVC and methacholine sensitivity were just as low at 9 years as it had been at 5 years of age. In conclusion, a large majority of asthmatic infants continue to be symptomatic between 5 and 9 years of age. The fact that the pulmonary function of asthmatic infants tends to remain stable after 5 years of age suggests that airway remodeling can occur at an early age. [Copyright &y& Elsevier]