Risk Factors for Early Remodelling in Severe Asthma in Children

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.
• •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).
• •* 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).