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Bronchial smooth muscle remodelling impacts the exacerbation frequency of severe preschool wheezers
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  • Fabien Beaufils,
  • Pauline Esteves,
  • Raphael Enaud,
  • Renaud Prevel,
  • Pauline Henrot,
  • Marilyne Campagnac,
  • Elise Maurat,
  • marine michelet,
  • Frederic Lavrand,
  • Hugues Bégueret,
  • Thomas Trian,
  • Michael Fayon,
  • Patrick Berger
Fabien Beaufils
Universite de Bordeaux

Corresponding Author:fabien.beaufils@u-bordeaux.fr

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Pauline Esteves
Universite de Bordeaux
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Raphael Enaud
Universite de Bordeaux
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Renaud Prevel
Universite de Bordeaux
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Pauline Henrot
Universite de Bordeaux
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Marilyne Campagnac
Universite de Bordeaux
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Elise Maurat
Universite de Bordeaux
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marine michelet
Centre Hospitalier Universitaire de Toulouse
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Frederic Lavrand
Centre Hospitalier Universitaire de Bordeaux
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Hugues Bégueret
Centre Hospitalier Universitaire de Bordeaux
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Thomas Trian
Universite de Bordeaux
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Michael Fayon
Universite de Bordeaux
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Patrick Berger
Universite de Bordeaux
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Abstract

INTRODUCTION: Exacerbations in preschool wheezers increase the risk of impaired lung function and asthma persistence at school age. Bronchial remodelling-based latent classes identify severe preschool wheezers at increased risk of frequent exacerbations (>3) but failed to distinguish those without exacerbation from those with low exacerbations rate (1-2 exacerbations) in the year following bronchoscopy. We thus aimed to identify further independent factors associated with no, low or high exacerbation rates. METHODS: In this post-hoc analysis, 80 severe preschool wheezers from the “P’tit Asthme” and “RESPIRE” studies were divided into 3 groups: No-Ex (0 exacerbation in the year following the bronchoscopy, n=20), Low-Ex (1-2 exacerbations, n=27) and High-Ex (≥3 exacerbations, n=33). Associations between variables and groups were assessed using multinomial logistic regressions. RESULTS: Atopic dermatitis, age at the first wheezing episode, Haemophilus and Streptococcus genera in the bronchoalveolar lavage fluid (BALF), bronchial smooth muscle (BSM) area, reticular basement membrane (RBM) thickness and RBM-BSM distance were all significantly different between No-Ex and/or Low-Ex and/or High-Ex. However, only atopic dermatitis, age at first episode of wheezing, Haemophilus genus in the BALF, RBM-BSM distance and BSM area were significantly and independently associated with exacerbation frequency. Among them, the BSM area was the sole parameter independently associated with each group. CONCLUSION: While atopic dermatitis, age at the first episode of wheezing, Haemophilus in BALF, RBM-BSM distance and BSM area appeared to be relevant independent parameters associated with exacerbation susceptibility in severe preschool wheezers, only the increased BSM area discriminated between each of the three-exacerbation frequency-based groups.