The Journal of allergy and clinical immunology · 2026
Age-dependent differences in airway inflammation and function in severe uncontrolled asthma.
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de Brito Jôse Mára, de Souza Xavier Costa Natália, Ferreira Diogenes Seraphim, Vergani Karina Pierantozzi, de Carvalho-Pinto Regina Maria, da Silva-Filho Luiz Vicente Ribeiro Ferreira, Athanazio Rodrigo Abensur, Rodrigues Joaquim Carlos, Mauad Thais, Eller Miriam Cardoso Neves
Аннотация
BACKGROUND: Endobronchial biopsy studies have deepened our understanding of airway inflammation and remodeling in severe asthma, but direct comparisons between pediatric and adult populations remain scarce.
OBJECTIVE: We compared the histopathologic and clinical characteristics of children and adults with severe uncontrolled asthma.
METHODS: Demographic, clinical, and laboratory data, lung function, fractional exhaled nitric oxide, and endobronchial biopsy samples were evaluated from 13 children and 36 adults with severe uncontrolled asthma.
RESULTS: The pediatric group had a higher proportion of boys, while girls predominated in adults. Children exhibited better lung function than adults (median percentage predicted forced expiratory volume in 1 second 82% vs 55%). In contrast, inflammatory cell densities were significantly higher in children across multiple airway compartments: elevated levels of eosinophils, chymase-positive mast cells, and CD8+ T cells in the intraepithelial layer; neutrophils, tryptase-positive mast cells, and chymase-positive mast cells in the airway smooth muscle layer; and eosinophils, tryptase-positive mast cells, and chymase-positive mast cells in the submucosal layer. In contrast, CD4+ T-cell density in the submucosal layer was higher in adults. Structural parameters, including basement membrane and epithelial thickness, collagen deposition, and airway smooth muscle/total tissue area, were similar between groups.
CONCLUSION: Children with severe asthma exhibit greater airway inflammation yet maintain better lung function compared to adults with similar structural remodeling. These findings highlight a potential therapeutical window in the pediatric population, emphasizing the need for age-tailored management approaches in severe asthma.
OBJECTIVE: We compared the histopathologic and clinical characteristics of children and adults with severe uncontrolled asthma.
METHODS: Demographic, clinical, and laboratory data, lung function, fractional exhaled nitric oxide, and endobronchial biopsy samples were evaluated from 13 children and 36 adults with severe uncontrolled asthma.
RESULTS: The pediatric group had a higher proportion of boys, while girls predominated in adults. Children exhibited better lung function than adults (median percentage predicted forced expiratory volume in 1 second 82% vs 55%). In contrast, inflammatory cell densities were significantly higher in children across multiple airway compartments: elevated levels of eosinophils, chymase-positive mast cells, and CD8+ T cells in the intraepithelial layer; neutrophils, tryptase-positive mast cells, and chymase-positive mast cells in the airway smooth muscle layer; and eosinophils, tryptase-positive mast cells, and chymase-positive mast cells in the submucosal layer. In contrast, CD4+ T-cell density in the submucosal layer was higher in adults. Structural parameters, including basement membrane and epithelial thickness, collagen deposition, and airway smooth muscle/total tissue area, were similar between groups.
CONCLUSION: Children with severe asthma exhibit greater airway inflammation yet maintain better lung function compared to adults with similar structural remodeling. These findings highlight a potential therapeutical window in the pediatric population, emphasizing the need for age-tailored management approaches in severe asthma.