Figures
- FIGURE 1
Flow-chart of the study. Between April 15, 2017 and September 30, 2019, 480 flexible bronchoscopies were performed under conscious sedation in Armand Trousseau Hospital for uncontrolled asthma in children. A total of 203 patients qualified for inclusion in the study.
- FIGURE 2
Distribution of virus and bacteria findings by sampling method. Results of the microbiological culture/detection were assessed for viruses and bacteria in bronchial aspiration, bronchoalveolar lavage or both.
Tables
- TABLE 1
Clinical characteristics of the included patients
Non-BAL group BAL group n p-value Subjects n 96 107 Male 63 (66) 61 (57) 124 0.21 Prematurity <35 WG 16 (17) 18 (17) 34 0.98 Age years (mean±sd) 2.24±2.12 5.53±4.13 203 <0.001 <3 years 72 (75) 42 (39) 114 <0.001 3–6 years 18 (19) 26 (24) 44 0.34 >6 years 6 (6.2) 39 (36) 45 <0.001 Age at onset months (mean±sd) 6.15±8.98 12.5±21.6 200 <0.01 Atopy Patient# 34 (47) 83 (84) 117 <0.001 Family# 70 (80) 90 (87) 160 0.14 Passive smoking# 29 (35) 37 (35) 66 0.99 Hospitalisation# 79 (84) 72 (68) 151 <0.01 Hospitalisation (mean±sd) 2.42±1.41 2.86±1.87 151 0.11 ICU hospitalisation# 22 (24) 16 (15) 38 0.12 Current asthma symptoms 29 (30) 4 (3.7) 33 <0.001 High-dose inhaled corticosteroids associated with another controller therapy# 24 (25) 70 (68) 94 <0.001 Uncontrolled or partially controlled asthma 72 (75) 85 (79) 157 0.45 Systematised alveolar opacities on chest radiography# 7 (8.1) 5 (5.4) 12 0.46 Elevated eosinophils >500 per mm3# 9 (13) 19 (19) 28 0.27 Lung function tests 3 (3.1) 36 (33.6) 39 <0.001 Normal 3 (100) 26 (72) 29 0.56 Data are presented as n (%) unless otherwise stated. High-dose inhaled corticosteroids: according to GINA, inhaled fluticasone >200 µg·day−1 for children under 6 years old and >500 µg·day−1 over 6 years of age, inhaled budesonide >400 µg·day−1 under 12 years old and >800 µg·day−1 over 12 years old; nebulised budesonide >1000 µg·day−1 for all children. BAL: bronchoalveolar lavage; WG: weeks of gestation; ICU: intensive care unit. #: based on 171 to 200 patients. Significant p-values appear in bold.
- TABLE 2
Basal treatment of the included patients
Non-BAL group BAL group Total p-value Subjects n 96 107 203 Controller steroid treatment No corticosteroids 4 (4.2) 1 (0.97) 0 (0) 0.19 Low-dose inhaled corticosteroids 3 (3.2) 6 (5.8) 4 (3.9) 0.5 Medium dose inhaled corticosteroids 15 (16) 14 (14) 15 (15) 0.66 High-dose inhaled corticosteroids 73 (77) 82 (80) 84 (82) 0.64 Oral corticosteroids 37 (39) 17 (16) 54 (26) <0.001 Bronchodilators Long-acting β-agonist 5 (5.2) 17 (16) 18 (17) 0.015 Short-acting β-agonist 47 (49) 83 (78) 87 (81) <0.001 Anticholinergic 13 (14) 75 (70) 76 (71) <0.001 Other Montelukast 15 (16) 22 (21) 16 (15) 0.36 Omalizumab 0 (0) 2 (1.9) 8 (7.5) 0.5 Antibiotics Azithromycin 2 (2.1) 5 (4.7) 31 (29) 0.45 Long-term antibiotics 1 (1) 3 (2.8) 14 (13) 0.62 Short-term antibiotics 8 (8.3) 1 (0.93) 48 (45) 0.014 Data are presented as n (%) unless otherwise stated.
- TABLE 3
Bronchoalveolar lavage (BAL) cell count according to age
Total population n (%) <3 years# (mean±sd) 3–6 years¶ (mean±sd) > 6 years+ (mean±sd) n p-value Total cells (103 per mL) 255 (175) 341±219 244±109 166±95.8 103 <0.001 Macrophages 83.6 (13.9) 82.4±16.3 83.4±10.8 85.1±13.2 105 0.43 Lymphocytes 10.5 (6.47) 10.2±6.12 13.7±7.80 8.57±4.96 105 <0.01 Neutrophils 4.48 (12.3) 7.44±16.4 2.19±2.75 2.73±10.4 105 0.0503 Eosinophils 1.00 (3.83) 0.131±0.314 0.269±0.992 2.50±6.16 105 <0.01 Data were available for 103 patients. #: n=41; ¶: n=25; +: n=37.
- TABLE 4
Viral infections in non-bronchoalveolar lavage (BAL) and BAL groups
All patients Non-BAL group (bronchial aspiration) BAL group p-value Subjects n 200 93 107 ≥1 infection 91 (45.5) 50 (52) 41 (38) 0.029 Adenovirus 21 (10.5) 18 (19) 3 (2.8) <0.001 Enterovirus 14 (7) 9 (9.7) 5 (4.7) 0.17 Parainfluenza virus 7 (3.3) 5 (5.4) 2 (1.9) 0.25 Metapneumovirus 4 (2) 4 (4.3) 0 (0) 0.045 Influenza virus# 8 (4) 6 (8.1) 2 (1.9) 0.067 Respiratory syncytial virus# 8 (4) 6 (8.1) 2 (1.9) 0.067 Rhinovirus¶ 37 (18.5) 12 (52) 25 (24) <0.01 Bocavirus¶ 10 (5) 4 (17) 6 (5.7) 0.079 Coronavirus¶ 10 (5) 2 (8.7) 8 (7.6) 1 Data are presented as n (%) unless otherwise stated. #: researched respectively in 74 patients in the non-BAL group and 105 patients in the BAL group; ¶: researched respectively in 23 patients in the non-BAL group and in 105 patients in the BAL group.
- TABLE 5
Adverse events of bronchoscopy and bronchoalveolar lavage (BAL)
Non-BAL group BAL group n p-value Subjects n 96 107 Midazolam dose mg·kg−1 (mean±sd) 0.397±0.231 0.264±0.0912 191 <0.001 During bronchoscopy Length of sedation min (mean±sd) 10.8±3.61 11.4±5.27 203 0.41 Poor bronchoscopy tolerance# 7 (7.7) 15 (15) 22 0.1 After bronchoscopy Fever 19 (20) 13 (12) 32 0.14 Bronchospasm 13 (14) 8 (7.5) 21 0.16 Oxygen requirement 18 (19) 9 (8.4) 27 0.03 ≥1 night hospitalisation 15 (16) 7 (6.5) 22 0.038 Data are presented as n (%) unless otherwise stated. #: during the bronchoscopy (hypoxia, significant cough, problems related to midazolam adverse side-effects). Significant p-values appear in bold.
Supplementary Material
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Supplementary material 00332-2021.SUPPLEMENT
