The endobronchial biopsy revealed evidence for mild eosinophilic inflammation

Case 3: An 8-year-old girl with a long history of severe, persistent, steroid-dependent asthma, developed respiratory symptoms at 10 months with a severe disease course since, requiring numerous hospitalizations and three episodes requiring intubation and mechanical ventilation. In addition, oral glucocorticoids were regularly administered since the age of 6 years, and frequent glucocorticoid bursts were required since the age of 1 year. Airway anatomy was normal with a minimally inflamed respiratory epithelial mucosa. The endobronchial biopsy revealed evidence for mild eosinophilic inflammation (Table 3).

Case 4: A 6-year-old girl with severe, persistent, steroid-dependent asthma developed respiratory symptoms at the age of 18 months. She required several hospitalizations and long-term oral glucocorticoid therapy since the age of 2 years. Medications on hospital admission included 10 mg of prednisone on alternate days, high-dose inhaled glucocorticoids, and theophylline. A prednisone burst was instituted secondary to significant diurnal variability (Fig 1, bottom, C) with FEV₁ values on awakening consistently < 50% of predicted. Despite a 6-day course of high-dose prednisone, lung function failed to significantly improve. A pharmacokinetic study found rapid prednisolone clearance. Methylprednisolone, 20 mg bid, was administered. After 30 days of high-dose, daily oral glucocorticoid therapy, her FEV₁ values slowly improved, yet airflow obstruction persisted with FEV₁/FVC ratios consistently < 0.80 (Fig 1, bottom, C).

Bronchoscopy with endobronchial biopsy was performed at the end of week 4. Airway anatomy was normal, while the airway mucosa appeared edematous. The BALF was unremarkable, while the endobronchial biopsy (Table 3) showed an intact but hyperplastic epithelium, significant squamous metaplasia, smooth-muscle hyperplasia, and a markedly thickened basement membrane (Fig 4). No airway inflammation was noted.

Case 5: A 15-year-old African-American girl had a long history of severe, persistent, steroid-dependant asthma, atopic dermatitis and respiratory symptoms developed at 2 years of age.