Abstract
Fiberoptic bronchoscopy allows inspection and biopsy of superficial airway structures, typically including epithelium, basement membrane, and lamina propria. Thus, mucosal structures and events can be studied, but the technique is less applicable to studies of smooth muscle.
Numerous bronchoscopic studies in adults have established the importance of helper T type 2 (Th2) lymphocyte-mediated, eosinophil-driven airway inflammation in adults with asthma. So commonplace is fiberoptic bronchoscopy in adult volunteers that serial bronchoscopies, for example, endobronchial segmental allergen challenges with repeat bronchoscopy, segmental lavage, and biopsy, are routinely performed.
Bronchoscopy has enabled fundamental questions about airway biology and pathophysiological mechanism of inflammation to be addressed, not only in the context of asthma. A MEDLINE search combining [asthma and biopsy and (airway or endobronchial or bronchial or mucosal)] yielded 162 references.
However, when this search was combined with [child or paediatric or pediatric or children] this was reduced to only three relevant hits, none of which were in the English language. One other study looked at changes after respiratory infection.
Articles about adults have sometimes contained material about older children, and there are occasional informative case reports. The questions that arise are as follows. 1.
Does this matter; are adults suitable models for pediatric asthma? 2. If it does matter, can we address this disparity through noninvasive testing? 3.
If noninvasive testing is not adequate, how can we safely and ethically perform more bronchoscopic studies? This article deals almost exclusively with asthma and related diseases. Other diseases are mentioned briefly.