Sociedad Iberoamericana de Informacion Cientifica (S I I C)
Determining which preschool-aged children with recurrent or persistent wheezing are likely to develop persistent asthma is difficult. The situation is compounded by the relatively poor response to anti-asthma treatment reported from most clinical trials in this age group. Recent publications have demonstrated that bronchoscopic assessment, including bronchoalveolar lavage (BAL) and endobronchial biopsy, can be performed safely in young children. We argue that such assessment could provide valuable information on the pathogenesis of asthma in early life and potentially allow the identification of which individual wheezy children are likely to progress to persistent asthma. Based on data in the literature, we contend that children who are at high risk of developing persistent asthma based on risk factors identified from longitudinal epidemiological studies (e. g. a family history of atopy and asthma; early allergic sensitization; clinical food allergy; eczema associated with atopy; and lower respiratory illnesses associated with wheezing in the first years of life) and who continue to wheeze beyond their third birthday would benefit from bronchoscopic evaluation. The presence of eosinophilic inflammation in BAL and/or biopsy and reticular basement membrane thickening may indicate a high likelihood of persistent asthma. However, the predictions need to be tested by collecting the appropriate data.