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Pulmonary sarcoidosis in children: Serial evaluation of bronchoalveolar lavage cells during corticosteroid treatment
Author(s) -
Chadelat Katarina,
Baculard Armelle,
Grimfeld Alain,
Tournier Guy,
Boule Michelle,
BocconGibod Liliane,
Clement Annick
Publication year - 1993
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950160109
Subject(s) - medicine , bronchoalveolar lavage , sarcoidosis , lymphocytosis , respiratory disease , corticosteroid , alveolar macrophage , lung , respiratory system , pulmonary function testing , cd8 , methylprednisolone , immunology , pathology , lymphocyte , gastroenterology , macrophage , immune system , biochemistry , chemistry , in vitro
Abstract The clinical course of sarcoidosis in children has not been well defined. Eight children with symptomatic sarcoidosis included in this study underwent pulmonary function tests and bronchoscopy with bronchoalveolar lavage (BAL) before treatment and during steroid therapy. At the start of therapy, functional parameters, mostly dynamic lung compliance and lung transfer factor for CO, were impaired. This was associated with abnormalities of BAL cell populations: increased total cell number with a high proportion of lymphocytes, modifications of lymphocyte subpopulation with an elevated CD4+/CD8+ ratio, and enhanced ability of alveolar macrophages to release hydrogen peroxide. Although respiratory abnormalities seemed to be similar at the initial stage of sarcoidosis in children and adults, the course of the disease appeared to be different. Despite the absence of respiratory symptoms and disappearance of chest radiographic abnormalities on prolonged steroid treatment, we found slow improvement of pulmonary functions associated with persistence of BAL lymphocytosis and elevated CD4+/CD8+ ratios. However, the ability of alveolar macrophages to release hydrogen peroxide was significantly reduced after 6 months of steroid treatment, and it remained identical to the control group. Therefore, the evaluation of disease activity appears to be critical for therapy in pediatrics, and for this purpose studies of alveolar macrophage activation may be of particular interest. Pediatr Pulmonol. 1993; 16:41–47. © 1993 Wiley‐Liss, Inc.