Risk Factors for Early Remodelling in Severe Asthma in Children (P'tit-ASTHME)

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

1. A continuous or semi continuous (≥ 50% of the year) by oral corticosteroids
2. 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)

1. The need for an additional daily treatment (β2-agonists, long-acting, theophylline, anti-leukotrienes)
2. Symptoms that require taking daily or almost daily of β2-agonists of short action
3. persistent obstruction (FEV <80% PEF variability> 20%) (If reliable spirometry, usually> 5 years of age)
4. One or more seeking care in emergency / year
5. At least three short courses of oral corticosteroids / year
6. Rapid Increases caused by the decrease of 25% of the dose of oral corticosteroids or inhaled
7. 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).