Respiratory Paediatrics, Royal Brompton Hospital London and NHLI Imperial College London, London, UK.
Allergy. 2013 Mar;68(3):402-6. doi: 10.1111/all.12101. Epub 2013 Jan 25.
The inflammatory phenotypes of severe asthma in adults may be reflected in peripheral blood. If this were true in children with severe therapy-resistant asthma (STRA), invasive tests could be avoided. At the moment there is no conclusive evidence in children.
All patients underwent blood tests, exhaled nitric oxide (FeNO), sputum induction, bronchoalveolar lavage (BAL) and endobronchial biopsy (EB).
Sixty-three (71.6%) patients had a normal blood profile and only 1/88 had a combined blood eosinophilia and neutrophilia. 76/88 (86%) had normal blood eosinophils, but of these, 84% had airway eosinophilia in either BAL (n = 43;66%) or EB (n = 41;79%). In children with STRA blood eosinophilia was associated with airway eosinophilia. However, normal blood eosinophil levels did not exclude airway eosinophilic inflammation.
Peripheral blood counts are not reliable in characterising airway inflammation in severe asthmatic children exposed to high dose steroid therapy, therefore bronchoscopy with BAL should be considered.
成人严重哮喘的炎症表型可能反映在外周血中。如果这在严重治疗抵抗性哮喘（STRA）的儿童中是正确的，那么可以避免侵入性检查。目前在儿童中尚无确凿证据。
所有患者均进行了血液检查、呼出气一氧化氮（FeNO）、痰诱导、支气管肺泡灌洗（BAL）和支气管内膜活检（EB）。
63 名（71.6%）患者的血液检查正常，88 名患者中仅有 1 名同时存在嗜酸性粒细胞和中性粒细胞增多。76/88（86%）患者的血液嗜酸性粒细胞正常，但其中 84%的患者在 BAL（n = 43；66%）或 EB（n = 41；79%）中存在气道嗜酸性粒细胞增多。在 STRA 儿童中，血液嗜酸性粒细胞增多与气道嗜酸性粒细胞增多相关。然而，正常的血液嗜酸性粒细胞水平并不能排除气道嗜酸性炎症。
在外周血暴露于高剂量类固醇治疗的严重哮喘儿童中，外周血计数不能可靠地描述气道炎症，因此应考虑支气管镜检查和 BAL。
