Aggiornamento
La bronchite eosinofila
Eosinophilic bronchitis: a clinical entity that also paediatricians should recognize and diagnose
Giorgio Longo, Laura Badina, Irene Berti, Massimo Maschio, Alessandro Amaddeo
IRCCS Mateno-Infantile “Burlo Garofolo”, Trieste
Ottobre 2025 - pagg. 489 -498 | DOI: 10.53126/MEB44489
Abstract
Eosinophilic bronchitis is a clinical entity characterized by bronchial eosinophilic inflammation that clinically manifests only with chronic, essentially dry cough. Just like asthma, it responds well to inhaled corticosteroid therapy, but it differs in that it is not associated with airflow variability, bronchial hyperreactivity, or response to beta-2 agonists. Because of the absence of these peculiar features of asthma, it is now labelled with the acronym NAEB (“Non-Asthmatic Eosinophilic Bronchitis”). The essential histopathological difference with asthma lies in the location of mast cells: in asthma, they are mainly found in the smooth muscle of the bronchial wall, while in NAEB they are essentially located on the epithelial surface, adjacent to the sensory nerve endings involved in the cough reflex. NAEB is not uncommon and is well described in adults, but it is overlooked or only briefly mentioned in the paediatric literature, probably because of the common habit of paediatricians to think of asthma first in any child with persistent or unexplained cough. Although inhaled corticosteroid therapy proves equally effective, it is important to diagnose eosinophilic bronchitis correctly because of its different therapeutic and prognostic implications.
Riassunto
La bronchite eosinofila, è un'entità clinica caratterizzata dall’infiammazione eosinofilica bronchiale che si esprime clinicamente con la sola tosse cronica, essenzialmente secca. Come l’asma risponde bene alla terapia con steroidi inalatori, ma se ne differenzia perché non si associa a variazioni del flusso aereo né a iperreattività bronchiale né risponde ai beta-2 agonisti. Per l’assenza di queste peculiari caratteristiche dell’asma viene oggi etichettata con l’acronimo NAEB (Non Asthmatic Eosinophilic Bronchitis). La differenza istopatologica essenziale con l’asma risiede nella posizione dei mastociti, che nell’asma sono prevalentemente localizzati nella muscolatura liscia della parete bronchiale mentre nella NAEB si trovano essenzialmente sulla superficie epiteliale in adiacenza delle terminazione sensitive implicate nel riflesso della tosse. Non rara e ben descritta nell’adulto, la NAEB viene scotomizzata, o solo appena nominata, dalla letteratura pediatrica, probabilmente per la comune abitudine del pediatra di pensare in prima battuta all’asma in ogni bambino con tosse persistente o non capita. Malgrado la terapia steroidea inalatoria risulti parimenti efficace, diagnosticare correttamente la bronchite eosinofila è utile per le diverse ricadute terapeutiche e prognostiche.
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Suggerite dall'AI
Classificazione MeSH
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Corrispondenza: giorgio.longo@burlo.trieste.it