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Benefits and risks of bronchoalveolar lavage in severe asthma in children

Raja Ben Tkhayat, Jessica Taytard, Harriet Corvol, Laura Berdah, Blandine Prévost, Jocelyne Just, Nadia Nathan
ERJ Open Research 2021 7: 00332-2021; DOI: 10.1183/23120541.00332-2021
Raja Ben Tkhayat
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
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Jessica Taytard
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
2Sorbonne Université, Inserm UMR_S_1158, Experimental and clinical respiratory neurophysiology, La Pitié Salpétrière Hospital, Paris, France
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Harriet Corvol
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
3Sorbonne Université, Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
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  • ORCID record for Harriet Corvol
Laura Berdah
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
3Sorbonne Université, Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
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Blandine Prévost
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
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Jocelyne Just
4Allergology Dept, APHP, Sorbonne Université, Armand Trousseau Hospital, Paris, France
6These authors contributed equally
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Nadia Nathan
1APHP, Sorbonne Université, Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
5Sorbonne Université, Inserm UMR S_933, Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
6These authors contributed equally
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  • For correspondence: nadia.nathan@aphp.fr
  • Article
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Figures

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  • FIGURE 1
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    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
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    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

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  • TABLE 1

    Clinical characteristics of the included patients

    Non-BAL groupBAL groupnp-value
    Subjects n96107
    Male63 (66)61 (57)1240.21
    Prematurity <35 WG16 (17)18 (17)340.98
    Age years (mean±sd)2.24±2.125.53±4.13203<0.001
     <3 years72 (75)42 (39)114<0.001
     3–6 years18 (19)26 (24)440.34
     >6 years6 (6.2)39 (36)45<0.001
    Age at onset months (mean±sd)6.15±8.9812.5±21.6200<0.01
    Atopy
     Patient#34 (47)83 (84)117<0.001
     Family#70 (80)90 (87)1600.14
    Passive smoking#29 (35)37 (35)660.99
    Hospitalisation#79 (84)72 (68)151<0.01
    Hospitalisation (mean±sd)2.42±1.412.86±1.871510.11
    ICU hospitalisation#22 (24)16 (15)380.12
    Current asthma symptoms29 (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 asthma72 (75)85 (79)1570.45
    Systematised alveolar opacities on chest radiography#7 (8.1)5 (5.4)120.46
    Elevated eosinophils >500 per mm3#9 (13)19 (19)280.27
    Lung function tests3 (3.1)36 (33.6)39<0.001
    Normal3 (100)26 (72)290.56

    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 groupBAL groupTotalp-value
      Subjects n96107203
      Controller steroid treatment
       No corticosteroids4 (4.2)1 (0.97)0 (0)0.19
       Low-dose inhaled corticosteroids3 (3.2)6 (5.8)4 (3.9)0.5
       Medium dose inhaled corticosteroids15 (16)14 (14)15 (15)0.66
       High-dose inhaled corticosteroids73 (77)82 (80)84 (82)0.64
       Oral corticosteroids37 (39)17 (16)54 (26)<0.001
      Bronchodilators
       Long-acting β-agonist5 (5.2)17 (16)18 (17)0.015
       Short-acting β-agonist47 (49)83 (78)87 (81)<0.001
       Anticholinergic13 (14)75 (70)76 (71)<0.001
      Other
       Montelukast15 (16)22 (21)16 (15)0.36
       Omalizumab0 (0)2 (1.9)8 (7.5)0.5
      Antibiotics
       Azithromycin2 (2.1)5 (4.7)31 (29)0.45
       Long-term antibiotics1 (1)3 (2.8)14 (13)0.62
       Short-term antibiotics8 (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)np-value
        Total cells (103 per mL)255 (175)341±219244±109166±95.8103<0.001
        Macrophages83.6 (13.9)82.4±16.383.4±10.885.1±13.21050.43
        Lymphocytes10.5 (6.47)10.2±6.1213.7±7.808.57±4.96105<0.01
        Neutrophils4.48 (12.3)7.44±16.42.19±2.752.73±10.41050.0503
        Eosinophils1.00 (3.83)0.131±0.3140.269±0.9922.50±6.16105<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 patientsNon-BAL group (bronchial aspiration)BAL groupp-value
          Subjects n20093107
          ≥1 infection91 (45.5)50 (52)41 (38)0.029
          Adenovirus21 (10.5)18 (19)3 (2.8)<0.001
          Enterovirus14 (7)9 (9.7)5 (4.7)0.17
          Parainfluenza virus7 (3.3)5 (5.4)2 (1.9)0.25
          Metapneumovirus4 (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 groupBAL groupnp-value
            Subjects n96107
            Midazolam dose mg·kg−1 (mean±sd)0.397±0.2310.264±0.0912191<0.001
            During bronchoscopy
             Length of sedation min (mean±sd)10.8±3.6111.4±5.272030.41
             Poor bronchoscopy tolerance#7 (7.7)15 (15)220.1
            After bronchoscopy
             Fever19 (20)13 (12)320.14
             Bronchospasm13 (14)8 (7.5)210.16
             Oxygen requirement18 (19)9 (8.4)270.03
             ≥1 night hospitalisation15 (16)7 (6.5)220.038

            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 Materials

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              Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

              Supplementary material 00332-2021.SUPPLEMENT

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            Benefits and risks of bronchoalveolar lavage in severe asthma in children
            Raja Ben Tkhayat, Jessica Taytard, Harriet Corvol, Laura Berdah, Blandine Prévost, Jocelyne Just, Nadia Nathan
            ERJ Open Research Oct 2021, 7 (4) 00332-2021; DOI: 10.1183/23120541.00332-2021

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            Benefits and risks of bronchoalveolar lavage in severe asthma in children
            Raja Ben Tkhayat, Jessica Taytard, Harriet Corvol, Laura Berdah, Blandine Prévost, Jocelyne Just, Nadia Nathan
            ERJ Open Research Oct 2021, 7 (4) 00332-2021; DOI: 10.1183/23120541.00332-2021
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