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PEDIATRICS Vol. 110 No. 2 August 2002, pp. 445

ASTHMA: PATHOPHYSIOLOGY

Airway Eosinophilia is Associated with Wheeze but is Uncommon in Children with Persistent Cough and Frequent Chest Colds

John M. Kelso, MD

San Diego, CA

Purpose of the Study. To evaluate sputum eosinophils in children with wheeze versus cough versus chest colds.

Study Population. A total of 83 children 8 to 11 years old recruited form primary schools in Australia based on a questionnaire regarding respiratory symptoms. Four groups: wheezed more than twice in last 12 months with or without colds (n = 28), night cough (but no wheeze) for at least 2 weeks in the last 12 months without colds (n = 12), chest colds (cough, but no wheeze) more than twice in last 12 months (n = 27) and control (no cough or wheeze) (n = 26).

Methods. Sputum induction.

Results. Median sputum eosinophil percentages were higher for children with wheeze (3.1%) than for children with cough (0.5%), chest colds (0%) or controls (0%) (P = .03). The percentage in each group with "eosinophilic bronchitis" (defined as sputum eosinophilia >2.5%) was 45%, 20%, 15% and 9.4%, respectively.

Conclusion. The authors conclude that "wheeze is a good discriminator for the presence of eosinophilic bronchitis, and that persistent cough and recurrent chest colds without wheeze should not be considered a variant of asthma."

Reviewer’s Comments. It is interesting to note the greater likelihood of finding sputum eosinophilia with wheeze as opposed to cough, however, I think it would be a mistake to dismiss the idea that chronic or recurrent cough, with or without viral respiratory infections, can be the sole manifestation of asthma. Sputum eosinophilia on a single induced sputum sample would not seem to be a gold standard for the diagnosis of asthma as fewer than half of those with recurrent wheeze had "eosinophilic bronchitis" and 15% to 20% of those with "variant asthma" did. Although other causes of chronic cough, such as tobacco exposure should be evaluated as the authors suggest, I believe a trial of asthma medication is often warranted in such children.

REFERENCES

Gibson PG, Simpson JL, Chalmers AC, et al. Am J Respir Crit Care Med.2001; 164 :977 –981[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kelso, J. M. Search for Related Content PubMed Articles by Kelso, J. M. Social Bookmarking                         What's this?