Children with asthma: research Canadian Health Care Mall
In this article Canadian Health Care Mall will look at the problem of childhood asthma.
This case series is obviously limited by sample bias, and small sample size precluding simple generalizations. In addition, we cannot comment on whether our subjects had elevated numbers of mast cells within their airways, as Giemsa staining was not performed. With that said, mast cells were not found to be elevated in the study by Wenzel who found no difference between the number of mast cells within the airways of severe asthmatics compared to mild asthmatics and control subjects. Children with asthma referred to NJMRC often are among the most severe. In addition, only a minority of the children referred to NJMRC undergo bronchoscopy with biopsy.
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Nevertheless, these cases are illustrative of the complexity of asthma and the inability to make simple structure-function correlations. The data suggest that airway inflammation may not be the sole mediator in the histopathology of asthma; any number of inflammation-independent factors might contribute. Review of the endobronchial biopsy specimens of each case revealed significant airway remodeling largely in the absence of significant airway inflammation. Of concern, these structural changes occurred despite long-term administration of high-dose inhaled and systemic glucocorticoid therapy. These observations demonstrate that extensive airway remodeling can be present in children with severe asthma, despite aggressive antiinflammatory therapy. As such, research must be directed at better understanding the mechanisms involved in airway structural changes and remodeling. Only when these mechanisms are elucidated can effective therapies be designed. It is likely that glucocorticoid-independent and glucocorticoid-insensitive mechanisms play a prominent role in these pathologic processes, further emphasizing the need for novel therapeutic approaches.
Study objectives: To determine if persistent airway tissue mast cells are associated with treatment failure when patients discontinue inhaled corticosteroids (ICS).
Design: Double-blind, randomized, placebo-controlled trial.
Setting: Multicenter, tertiary referral centers.
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