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The impact of adenotonsillectomy on pediatric asthma
Nira A Goldstein1, Maxwell S Thomas1, Yasong Yu1
1Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center and Department of Otolaryngology, New York City Health + Hospitals/ Kings County, Brooklyn, New York.
Insights
Adenotonsillectomy (T&A) improved asthma control in children with sleep-disordered breathing (SDB). T&A surgery positively impacted asthma outcomes, as measured by the Childhood Asthma Control Test (C-ACT).
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Sleep Medicine
Background:
- Sleep-disordered breathing (SDB) is common in children with asthma.
- Adenotonsillectomy (T&A) is a primary treatment for SDB in children.
- The impact of T&A on asthma control remains an area of investigation.
Purpose of the Study:
- To evaluate asthma outcomes in pediatric patients undergoing T&A for SDB.
- To compare asthma control in children with SDB treated with T&A versus those managed non-surgically.
Main Methods:
- Prospective cohort study involving 80 children (aged 4-11) with asthma undergoing T&A and 62 matched controls.
- Childhood Asthma Control Test (C-ACT) and Pediatric Sleep Questionnaire (PSQ) administered at baseline and 6 months post-entry.
- Asthma exacerbations, systemic steroid use, ER visits, and hospitalizations were recorded.
Main Results:
- A significant improvement in C-ACT scores was observed in the T&A group compared to the control group at 6-month follow-up (p=0.006).
- No significant differences in other asthma clinical outcomes were detected, though these were infrequent.
- Baseline PSQ scores predicted C-ACT score improvements.
Conclusions:
- T&A surgery for SDB in children with asthma leads to improved asthma control.
- Treatment of SDB through T&A positively influences asthma management and patient-reported outcomes.
- Further research may explore specific SDB phenotypes that benefit most from T&A regarding asthma control.
Objective:
To determine asthma outcomes in children undergoing adenotonsillectomy (T&A) for treatment of sleep-disordered breathing (SDB).
Hypothesis:
Asthmatic children will demonstrate improvement in asthma control after T&A compared to asthmatic children not undergoing surgical treatment.
Study Design:
Prospective cohort.
Patient-Subject Selection:
80 children with diagnosed asthma, aged 4-11, undergoing T&A and 62 controls matched to the T&A subjects by age, sex, and asthma severity classification.
Methodology:
Parents and children completed the Childhood Asthma Control Test (C-ACT) and the Pediatric Sleep Questionnaire (PSQ). Parents were queried regarding the number of asthma exacerbations, the frequency of the use of systemic steroids, the number of emergency room visits and the number of hospitalizations in the prior 6 months. The identical questionnaires and interviews were completed 6 months after entry.
Results:
The adjusted mean (95% CI) C-ACT score was 21.86 (20.94-22.68) at entry and 25.15 (24.55-25.71) at follow-up for the T&A group compared with 22.42 (21.46-23.28) and 23.59 (22.77-24.33) for the control group. There was a significant group by time interaction (P < 0.001). Simple effects analysis showed that group means did not differ at entry (P = 1.00) but did differ at follow-up (P = 0.006). Baseline PSQ was a significant predictor of improvement in C-ACT scores. Statistical modeling did not demonstrate significant group by time interactions for any of the asthma clinical outcomes, although these outcomes were very infrequent in both groups.
Conclusion:
Treatment of SDB improves asthma outcomes as measured by the C-ACT.
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