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Improvement in asthma control and inflammation in children undergoing adenotonsillectomy
Jonathan C Levin1, Lisa Gagnon2, Xiaoxuan He1
1Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, Connecticut.
Insights
Adenotonsillectomy improved asthma control in children, particularly those with high preoperative chitinase activity. This suggests the procedure impacts airway inflammation by modulating chitinase levels.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Biomarkers of Inflammation
Background:
- Asthma control may improve post-adenotonsillectomy, but limited longitudinal data exists on airway inflammation biomarkers.
- Adenotonsillectomy is a common procedure in children, with potential benefits for respiratory conditions.
Purpose of the Study:
- To investigate the longitudinal effect of adenotonsillectomy on asthma control and chitinase activity.
- To correlate pre-operative chitinase levels with post-operative asthma outcomes.
Main Methods:
- A longitudinal observational study involving pediatric patients undergoing adenotonsillectomy.
- Measurement of Asthma Control Test (ACT) scores and serum chitinase activity at baseline and 6-month follow-up.
Main Results:
- Asthma Control Test scores significantly improved by 3 points post-surgery (P < 0.001).
- 85% of poorly controlled asthmatics showed improved control or reduced healthcare utilization.
- Chitinase activity decreased in asthmatics with improved control, and higher baseline levels predicted better outcomes (P < 0.01).
Conclusions:
- Adenotonsillectomy significantly improves asthma control and reduces healthcare utilization in children with high baseline chitinase activity.
- The procedure appears to modulate chitinase activity, suggesting an impact on airway inflammation and disease severity.
Background:
Observational studies suggest that asthma control improves after adenotonsillectomy, but longitudinal studies that correlate the effect of the procedure on the levels of biomarkers associated with airway inflammation are limited.
Methods:
We conducted a longitudinal, observational study on pediatric patients, both with and without asthma, undergoing adenotonsillectomy. Asthma control test (ACT) scores and chitinase activity in the circulation were measured at time of surgery and at 6-mo follow-up.
Results:
Sixty-six children with asthma and 64 control subjects were enrolled. Mean ACT scores improved by three points (P < 0.001) after 6 mo. 85% of children with poorly controlled asthma demonstrated an increase in ACT score of at least three points or a decrease in emergency department/urgent care visits, oral corticosteroid courses, or rescue short acting bronchodilator usage. Chitinase activity decreased significantly in asthmatics who improved (P < 0.01). Higher chitinase activity levels at baseline were associated with improved asthma control following surgery (P < 0.01).
Conclusion:
In children with high preoperative circulating chitinase activity levels, asthma control and healthcare utilization were significantly improved after adenotonsillecotmy. Chitinase activity decreased after surgery in children with improved control. This suggests that adenotonsillectomy modulates chitinase activity, affecting airway inflammation and improving airway disease.
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