Risk Factors for Early Remodelling in Severe Asthma in Children

Inclusion criteria

Asthmatic children

• Parents (and possibly the child) who gave written informed consent.
• Affiliated with a social security scheme.
• Age from 1 to less than 5 years.
• Severe persistent asthma according to the criteria of the National Health Authority (Annex I) or NEW PROPOSED CRITERIA (adapted ATS (42)):

Major criteria (> 1) Asthma control in mild to moderate level requiring

• A continuous or semi continuous (≥ 50% of the year) by oral corticosteroids
• A treatment with high doses of inhaled corticosteroids (> 500 micrograms / day of Beclomethasone, or equivalent (> 400 micrograms / day of Budesonide,> 200 micrograms / day of Fluticasone) for at least 6 weeks.

And

minor criteria (> 2)

• The need for an additional daily treatment (β2-agonists, long-acting, theophylline, anti-leukotrienes)
• Symptoms that require taking daily or almost daily of β2-agonists of short action
• persistent obstruction (FEV <80% PEF variability> 20%) (If reliable spirometry, usually> 5 years of age)
• One or more seeking care in emergency / year
• At least three short courses of oral corticosteroids / year
• Rapid Increases caused by the decrease of 25% of the dose of oral corticosteroids or inhaled
• ATCD of severe acute asthma who put in life-threatening

Non-asthmatic children

• Non asthmatic child with indication of endoscopy:

• Any endoscopy for a disease without acute or chronic inflammation in the biopsy area (≥1 to <5 years (1st part): congenital stridor, double aortic arch, foreign body removal inhaled, ...; ≥ 7 to ≤ 10 years ( 2nd component): inhaled foreign body removal, ...).
• Parents (and possibly the child) who gave written informed consent.
• Affiliated with a social security scheme.
• Children not asthmatic postmortem (retrospective and prospective)

• Age from 1 to under 5 (1st part) or aged 7 to 10 years (2nd part) on the death
• Died without pulmonary pathology in the sampled area
• Non asthmatic child with thoracic surgery:

• Age from 1 to under 5 (1st part) or aged 7 to 10 years (2nd part).
• Subject with pulmonary pathology, requiring thoracic surgery lobectomy, non-inflammatory in the sampled area.
• Parents (and possibly the child) who gave written informed consent.
• Affiliated with a social security scheme.

Exclusion criteria

Asthmatic children:

• Subject having a severe exacerbation of asthmatic disease requiring hospitalization in the 3 weeks preceding their inclusion.
• exclusion period on topic compared to another protocol.
• Subject with significant co-morbidity associated with asthma not of any nature whatsoever
• bronchial malformations (exclusion criterion ex post).
• Subject with a dental infection, or nasopharyngeal airway (viral or bacterial) with fever (> 39 ° C) in the 4 weeks preceding the survey.
• chronic viral infections (hepatitis, HIV).
• non-specific inclusion criteria to endoscopy:
• Review of hemostasis abnormal,
• Subject with a heart condition,
• Subject is not fasted for over 6 hours.

Children without asthma:

• Non-asthmatic children with indication of endoscopy:

• asthma diagnosed by a doctor.
• exclusion period on topic compared to another protocol.
• Subject with significant co-morbidity associated with asthma not of any nature whatsoever.
• bronchial malformations (exclusion criterion ex post).
• Subject with a dental infection, or nasopharyngeal airway (viral or bacterial) with fever (> 39 ° C) in the 4 weeks preceding the survey.
• chronic viral infections (hepatitis, HIV).
• non-specific inclusion criteria to endoscopy:
• Review of hemostasis abnormal,
• Subject with a heart condition,
• Subject is not fasted for over 6 hours.
• Children postmortem non-asthmatics:

• asthma diagnosed by a doctor.
• Subject with a dental infection, or nasopharyngeal airway (viral or bacterial) with fever (> 39 ° C) within 4 weeks before sampling of tissue.
• chronic viral infections (hepatitis, HIV).
• Non-asthmatic children with thoracic surgery:

• asthma diagnosed by a doctor.
• exclusion period on topic compared to another protocol.
• Subject with a dental infection, or nasopharyngeal airway (viral or bacterial) with fever (> 39 ° C) within 4 weeks before sampling of tissue.
• chronic viral infections (hepatitis, HIV).