Bronchial remodelling effective in identifying exacerbations in severe preschool wheezers

Children with preschool wheezing represent a heterogeneous population with wide variability regarding their clinical, inflammatory, obstructive, and/or remodelling patterns. We hypothesized that assessing bronchial remodelling would help clinicians to better characterize severe preschool wheezers.

The main objective was identifying bronchial remodelling-based latent classes of severe preschool wheezers. Secondary objectives were to compare cross-sectional and longitudinal clinical and biological data between classes and assess bronchoscopy's safety.

This double-centre prospective study (NCT02806466) included severe preschool wheezers (1-5 years old), requiring fiberoptic bronchoscopy. Bronchial remodelling parameters (i.e., epithelial integrity, reticular basement membrane (RBM) thickness, mucus gland, fibrosis and bronchial smooth muscle (BSM) areas, the density of blood vessels, and RBM-BSM distance) were assessed and evaluated by Latent Class Analysis. An independent cohort of severe preschool wheezers (NCT04558671) was used to validate our results.

The results are:

• Fiberoptic bronchoscopy procedures were well tolerated.
• A two-class model was identified: Class BR1 was characterized by increased RBM thickness, normalized BSM area, the density of blood vessels, and decreased mucus gland area, fibrosis and RBM-BSM distance compared to Class BR2.
• No significant differences were found between classes in the year prior to fiberoptic bronchoscopy. By contrast, Class BR1 was associated with a shorter time to first exacerbation and an increased risk of both frequent (>3) and severe exacerbations during the year following bronchoscopy in the two cohorts.

Thus, assessing bronchial remodelling identified severe preschool wheezers at risk of frequent and severe subsequent exacerbations with a favourable benefit-to-risk ratio.

Reference:

Michael Fayon et al. Bronchial Remodeling-based Latent Class Analysis Predicts Exacerbations in Severe Preschool Wheezers. https://doi.org/10.1164/rccm.202205-0913OC PubMed: 36108144

Keywords:

Bronchial, Remodeling, based, Latent, Class, Analysis, Predicts, Exacerbations, Severe, Preschool Wheezers, Michael Fayon ; Fabien Beaufils , Pauline Esteves , Marilyne Campagnac ; Elise Maurat , Marine Michelet , Valerie Siao-Him-Fa ; Frederic Lavrand , Guillaume Simon , Hugues Begueret , and Patrick Berger, American Journal of Respiratory and Critical Care Medicine, Asthma; Child; Bronchoscopy; Latent Class Analysis; Exacerbation