Bronchoalveolar Eosinophilia in children with protracted bacterial bronchitis

<bold>Introduction</bold> Chronic wet cough is the main symptom of protracted bacterial bronchitis (PBB). Establishing the diagnosis of accompanying asthma is quite difficult, especially in young children. <bold>Aim</bold> The potential coexistence of asthma in young children with PBB. <bold>Method</bold> The study included children 2–4-year-old presenting with chronic wet cough, partially responded to conventional antibiotic courses, during the last six years. All children were bronchoscoped, and bronchoalveolal lavage (BAL) was obtained and analyzed. Clinical characteristics, imaging findings, atopic history, response to asthma treatments and laboratory findings were also recorded. Children with recent infection were excluded. <bold>Results:</bold> Altogether, 38 children with chronic wet cough were bronchoscoped. Bacteria>105 /ml were isolated in 30 children (78.9%) – H. influenzae (16/30, 53.3%), M. cattarhalis (8/30, 26.7%) and St. pneumonia (6/30, 20%). BAL cytology revealed mild eosinophilia (2-8%, median 5.3%) in 12/38 (31.5%) patients. Comparing patients with BAL eosinophilia to those without, the first group exhibited a repetitive response to salbutamol and/or inhaled corticosteroids (12 vs 2 patients), wheezing episodes (7 vs 2), atopic dermatitis (5 vs 1) and positive allergy tests (5 vs 1). Blood eosinophils were within normal range and imaging findings were similar in both groups. <bold>Conclusions:</bold> BAL eosinophilia may serve as an asthma pointer in a subgroup of PBB patients. These findings support the ongoing debate about the PBB spectrum and the wheezing illness in preschoolers.