• Ruth O'Reilly, Nicola Ullmann, Samantha Irving, Cara J Bossley, Samatha Sonnappa, Jie Zhu, Timothy Oates, Winston Banya, Peter K Jeffery, Andrew Bush, and Sejal Saglani.
• Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
• J. Allergy Clin. Immunol. 2013 Apr 1; 131 (4): 1024-32, 1032.e1-16.

BackgroundIncreased airway smooth muscle (ASM) is a feature of established asthma in schoolchildren, but nothing is known about ASM in preschool wheezers.ObjectiveWe sought to determine endobronchial biopsy specimen ASM area fraction in preschool wheezers and its association with asthma at school age.MethodsASM area, reticular basement membrane thickness, and mucosal eosinophil and ASM mast cell values were quantified in endobronchial biopsy specimens previously obtained from preschool children undergoing clinically indicated bronchoscopy: severe recurrent wheezers (n=47; median age, 26 months) and nonwheezing control subjects (n=21; median age, 15 months). Children were followed up, and asthma status was established at age 6 to 11 years. Preschool airway pathology was examined in relation to asthma at school age.ResultsForty-two (62%) of 68 children had 1 or more evaluable biopsy specimens for ASM. At school age, 51 of 68 children were followed up, and 15 (40%) of 37 preschool wheezers had asthma. Children who had asthma and an evaluable biopsy specimen had increased preschool ASM area fraction (n=8; median age, 8.2 years [range, 6-10.4 years]; median ASM, 0.12 [range, 0.08-0.16]) compared with that seen in children without asthma (n=24; median age, 7.3 years [range, 5.9-11 years]; median ASM, 0.07 [range, 0.02-0.23]; P=.007). However, preschool reticular basement membrane thickness and mucosal eosinophil or ASM mast cell values were not different between those who did or did not have asthma at school age.ConclusionIncreased preschool ASM is associated with those children who have asthma at school age. Thus a focus on early changes in ASM might be important in understanding the subsequent development of childhood asthma.Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

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