Results:
Records from a total of 43
children ≤ 36 months old [median 14 months (range 3-36 months)] on
ICS therapy were included in the analysis. The majority of patients were
API positive. (Table 1). Median BAL eosinophil percentages were low in
both API -ve and API +ve groups and were comparable to expected normal
values from the literature17 with a median (range)of
1% (1-2%) in API -ve and 1% (1-11%) in API +ve patients (Figure
1-a). Only 3 patients with +ve API had eosinophils ≥ 2%. Increased
neutrophil percentages compared to literature
controls17 were present in both API groups with a
median 16% neutrophils (1-76%) in API -ve and 42% neutrophils
(1-95%) in API +ve patients; (P = 0.09). (Figure 1-a). Cell percentages
(median (range)) were similar for lymphocytes and macrophages between
API groups with 12% lymphocytes (1-30%) in API -ve and 7% lymphocytes
(1-37%) in API +ve groups; 67.5% macrophages (12-97%) in API -ve and
41% macrophages (2-94%) in API +ve groups (Figure 1-a). No difference
was found between any cell type percentage comparing API groups after
exclusion of samples with positive BAL cultures (bacterial and viral)
(Figure 1-b); however, neutrophil percentages remained higher than
expected in both groups. Patients with positive cultures (bacterial or
viral) had significantly higher neutrophil percentages compared to
patients with negative cultures in both API groups in combined
(p=0.0001) . (Figure 2, Table 2).
There was no significant difference in culture results (bacterial and
viral) comparing API groups (Table 1). There was correlation between
neutrophil percentages and positive bacterial (R=0.6, p ‹0.001) and
viral cultures (R=0.3, p=0.01). 25% of total patients had mixed
(bacterial and viral) cultures. M. catarrhalis was the most
commonly isolated organism (8 patients), followed by Streptococcus
pneumoniae (5 patients) and a significant growth of mixed organisms (5
patients). Two patients grew H. influenzae . Viruses isolated
include Rhinovirus (3 patients) Coxackie/Echo virus (4 patients),
Adenovirus (2 patients) and CMV (1 patient). Three patients had a mixed
culture of CMV with another virus (Rhinovirus, Coxackie virus and Corona
virus). One patient had a mixed culture of Adenovirus with Parainfluenza
virus. Thirty three percent of all patients had LLM% ≥ 20% in their
BAL; however, LLM% did not differ by API, culture status, or cell
percentages.