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The relationship between inflammation and remodeling in childhood asthma: a systematic review

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Title: The relationship between inflammation and remodeling in childhood asthma: a systematic review
Authors: Castro-Rodriguez, JA
Saglani, S
Rodriguez-Martinez, CE
Oyarzun, MA
Fleming, L
Bush, A
Item Type: Journal Article
Abstract: OBJECTIVES: We aimed to perform a systematic review of all studies with direct measurements of both airway inflammation and remodeling in the subgroup of children with repeated wheezing and/or persistent asthma severe enough to warrant bronchoscopy, to address whether airway inflammation precedes remodeling or is a parallel process, and also to assess the impact of remodeling on lung function. METHODS: Four databases were searched up to June 2017. Two independent reviewers screened the literature and extracted relevant data. RESULTS: We found 526 references, and 39 studies (2390 children under 18 years old) were included. Airway inflammation (eosinophilic/neutrophilic) and remodeling were not present in wheezers at a mean age of 12 months, but in older pre-school children (mean 2.5 years), remodeling (mainly increased reticular basement membrane [RBM] thickness and increased area of airway smooth muscle) and also airway eosinophilia was reported. This was worse in school-age children. RBM thickness was similar in atopic and non-atopic preschool wheezers. Airway remodeling was correlated with lung function in seven studies, with FeNO in three, and with HRCT-scan in one. Eosinophilic inflammation was not seen in patients without remodeling. There were no invasive longitudinal or intervention studies. CONCLUSION: The relationship between inflammation and remodeling in children cannot be determined. Failure to demonstrate eosinophilic inflammation in the absence of remodeling is contrary to the hypothesis that inflammation causes these changes. We need reliable, non-invasive markers of remodeling in particular if this is to be addressed.
Issue Date: 1-Jun-2018
Date of Acceptance: 25-Jan-2018
URI: http://hdl.handle.net/10044/1/57369
DOI: https://dx.doi.org/10.1002/ppul.23968
ISSN: 1099-0496
Publisher: Wiley
Start Page: 824
End Page: 835
Journal / Book Title: Pediatric Pulmonology
Volume: 53
Issue: 6
Copyright Statement: © 2018 Wiley Periodicals, Inc. This is the accepted version of the following article, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1002/ppul.23968/abstract
Sponsor/Funder: Asthma UK
British Medical Association
Royal Brompton & Harefield NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
Asthma UK
Royal Brompton & Harefield NHS Foundation Trust
Wilhelm Doerenkamp-Stiftung Chur
Asthma UK
National Institute for Health Research
National Institute for Health Research
Asthma UK
National Institute for Health Research
Wellcome Trust
Funder's Grant Number: 02/034
DPA/nj
B1057
N/A
X
B6105
n/a
08/010
BRU 6279
N/A
AUK-IG-2014-287
CDF-2014-07-019
108818/Z/15/Z and 108818/Z/15/
Keywords: Science & Technology
Life Sciences & Biomedicine
Pediatrics
Respiratory System
airway biopsy
airway inflammation
airway remodeling
asthma
bronchial biopsy
bronchoalveolar lavage
children
infants
wheezing
RETICULAR BASEMENT-MEMBRANE
EOSINOPHIL CATIONIC PROTEIN
PEDIATRIC SEVERE ASTHMA
AIRWAY SMOOTH-MUSCLE
LUNG-FUNCTION
PRESCHOOL WHEEZERS
DIFFICULT ASTHMA
YOUNG-CHILDREN
ALLERGEN CHALLENGE
ATOPIC ASTHMA
1114 Paediatrics And Reproductive Medicine
Publication Status: Published
Conference Place: United States
Online Publication Date: 2018-02-22
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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