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membrane thickening) were present early in a study in children with an age range down to 1.2
years (Pohunek, Warner et al. 2005) and did not show differences between those with few
symptoms compared to those with persistent symptoms or 'difficult to control' asthma
(cokugras, Akcakaya et al. 2001; Jenkins, cool et aL.2003; payne, Rogers et al.29613; de
Blic, Tillie-kblond et al. 2004; Fedorov, Wilson et al. 2005). In addition, the findings were
not associated with age, length of symptoms, lung function or bronchial reactivity (payne,
Rogers et al. 2003). Bronchial wall thickening on high resolution computerized tomography
(HRCT) scan was shown to correlate with eosinophils numbers, ECp and sub-basement
membrane thickening (de Blic, Tillie-Irblond et al. 2005).
1.6.3 studies of inflammation using bronchoalveolar lavage
In adults the standard bronchoscope wedges between the 4th and 6ft order bronchus
(Hunninghake, Gadek et al. 1979) typically localising a lung zone with 106 alveoli or a
volume of l65ml at total lung capacity and 45ml at residual volume. In the 1960s, two studies
initially started using catheters to do small volume bronchopulmonary lavage for assessment
of disease @nley, Swenson et al. 1967; pratt, Finley et al. 1969). standard guidelines for
clinical, diagnostic and research practices have been developed for use in adults (Klech and
Pohl 1989; American Thoracic Society 1990; Rennard, Aalbers et al. 1998; Reynolds 2000),
and more recently for use in children (ERS 2000; Midulla, de Blic et al. 2003). Lavage studies
have confirmed many of the biopsy study findings in asthmatics when compared to normal
subjects. Increases are seen in eosinophils, T-lymphocytes, eosinophilic proteins and
cytokines such as n-4,L5, rantes and chemo-attractant factors with excellent recent reviews
detailing these findings (Barrios, Kheradmand et aL.2006; Graham 2006: Tulic and Hamid
2006). An antigenic or exercise challenge resulted in an observed increase in eosinophils
(Kirby, Hargreave et al. 1987; Wardlaw, Dunnette et al. 1988; Bousquet, Van Vyve et al.
1993; Krug, Tschernig et al. 2001), T cell lymphocytes (Virchow, Walker et al. 1995;
Schuster, Tschernig et al. 2000), mast cells (Kirby, Hargreave et al. 1987; Bousquet, Van
Vyve et al. 1993; Olsson, Rak et al. 2000), basophils and neutrophils (Kirby, Hargreave et al.
1987; Mattoli, Mattoso et al. 1991; Bousquet, Van Vyve et al. 1993), complement factors
C3A and C5 (Krug, Erpenbeck et al. 2001) and eosinophilic proteins (Wardlaw, Dunnette et
al. 1988).
Many more proteins can be measured in lavage fluid and this can demonstrat e the effect of
cells' even if the latter are not as visible. For example, mast cells account for up to 20Vo of the
inflammatory cells and basophils are also prominent in biopsy studies, but both are only a
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