Blood eosinophil counts rarely reflect airway eosinophilia in children with severe asthma

Allergy. 2013 Mar;68(3):402-6. doi: 10.1111/all.12101. Epub 2013 Jan 25.


Background: The inflammatory phenotypes of severe asthma in adults may be reflected in peripheral blood. If this were true in children with severe therapy-resistant asthma (STRA), invasive tests could be avoided. At the moment there is no conclusive evidence in children.

Methods: All patients underwent blood tests, exhaled nitric oxide (FeNO), sputum induction, bronchoalveolar lavage (BAL) and endobronchial biopsy (EB).

Results: Sixty-three (71.6%) patients had a normal blood profile and only 1/88 had a combined blood eosinophilia and neutrophilia. 76/88 (86%) had normal blood eosinophils, but of these, 84% had airway eosinophilia in either BAL (n = 43;66%) or EB (n = 41;79%). In children with STRA blood eosinophilia was associated with airway eosinophilia. However, normal blood eosinophil levels did not exclude airway eosinophilic inflammation.

Conclusions: Peripheral blood counts are not reliable in characterising airway inflammation in severe asthmatic children exposed to high dose steroid therapy, therefore bronchoscopy with BAL should be considered.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asthma / complications*
  • Asthma / diagnosis*
  • Bronchoalveolar Lavage Fluid / immunology
  • Child
  • Eosinophilia / complications*
  • Eosinophils*
  • Female
  • Humans
  • Leukocyte Count
  • Male
  • Neutrophils
  • Prognosis