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. 2007 Aug 28;42(10):857–863. doi: 10.1002/ppul.20648

Comparison of atopic and nonatopic children with chronic cough: Bronchoalveolar lavage cell profile†

Flavia de A Ferreira 1,2,✉, Luiz Vicente F Silva Filho 1, Joaquim Carlos Rodrigues 1, Andrew Bush 2, Patricia L Haslam 3
PMCID: PMC7168020  PMID: 17726706

Abstract

Chronic cough is a common complaint in children and its relationship with asthma is controversial. The aim of the present study was to determine the pattern of airway inflammation in atopic and nonatopic children with chronic cough, and to investigate whether atopy is a predictive factor for eosinophilic inflammation in cough. Bronchoalveolar lavage (BAL; three aliquots of 1 ml/kg saline) was performed in the right middle lobe of 24 (11 atopic and 13 nonatopic) children with persistent cough (8 females, 16 males), mean age 4.7 years (range: 1–11). Atopy was defined as an elevated total serum IgE or a positive RAST test. Both atopic and nonatopic children with persistent cough had an increase in total cells/ml in BAL (atopic: median 39 × 104, range: 20–123; nonatopic: median 22 × 104, range: 17–132) compared to nonatopic controls (median 11 × 104, range 9–30). The increases were mainly in neutrophils (atopic: median 17%, range 2.5–88.5%; nonatopic: median 6%, range 1.0–55.0%) compared to controls (median 1.55%, range 0.5–7.0%; atopics vs. controls, P < 0.005). There were no significant increases in eosinophils, lymphocytes, epithelial cells, or mast cells. Eosinophils were elevated in only 5/11 atopic and none of the nonatopic children. The increased percentage of neutrophils in the BAL fluid of atopic and nonatopic children with persistent cough could be due to an underlying inflammatory process driving the cough, or even conceivably, due to the effect of coughing itself. In this highly selected series, the absence of eosinophilic inflammation in the majority suggests that most would be predicted not to respond to inhaled corticosteroid therapy. This study underscores the need to be cautious about treating coughing children with inhaled corticosteroids, even in the context of a tertiary referral practice. Pediatr Pulmonol. 2007;42:857–863. © 2007 Wiley‐Liss, Inc.

Keywords: children, neutrophils, chronic cough, atopy, bronchoalveolar lavage, asthma, eosinophils

†

Presented at 2003 BTS Winter Meeting, London, United Kingdom, 2004 ATS International Conference in Orlando, Florida, 2004 Brazilian Pediatric Pulmonology Conference, Rio de Janeiro, Brazil.

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