A microscopic study of washed sputum was performed in infants and children with disorders of the lower respiratory tract to investigate the clinical significance of its cytological features (alveolar macrophages or dust cells, ciliated epithelium, lymphocytes, neutrophils, eosinophils, and squamous epithelial metaplasia) in etiologic diagnosis and in asthma of infancy and childhood, with the results leading to the conclusions as follows: 1) In allergic bronchitis, asthma and chronic bronchitis, increased eosinophils (〓to〓) were significantly more frequent (p<0.01) than in acute lower respiratory tract infections. None of the latter patients showed a plus 3 or greater degree of eosinophilia in washed sputum. 2) Squamous epithelial metaplasia was demonstrable with higher incidence in recurrent or chronic lower respiratory tract disorders, particularly in chronic bronchitis (55.2%), compared with acute lower respiratory tract disorders, the difference being statistically significant (p<0.01). In children with asthma, this cytological feature was noted to be significantly more frequent with the perennial type (39.4%) in comparison with the seasonal type (p<0.05). 3) Data analysis of incidence and degree of increased eosinophils related to prognosis in these conditions showed a higher but not statistically significant rate of outgrow for patients with eosinophilia of bronchial secreta. 4) As for interrelation of respiratory tract infection (viral or bacterial) and cytologic findings pathognomonic of such infection during the attack of asthma, increased neutrophils (plus 3 or more) were significantly higher in incidence with cases positive for bacterial pathogens as compared to negative cases (p<0.01), irrespective of presence or absence of symptoms and signs of infection. No conclusive data could be obtained, however, from a few cases of viral infection which did not permit trend analysis.
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