Improvement in asthma control and inflammation in children undergoing adenotonsillectomy

Abstract

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-month follow-up. Results 66 children with asthma and 64 control subjects were enrolled. Mean ACT scores improved by 3 points (p< 0.001) after 6 months. 85% of children with poorly-controlled asthma demonstrated an increase in ACT score of at least 3 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). Conclusions In children with high pre-operative 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.

The impact of adenotonsillectomy on pediatric asthma

“…al demonstrated significant decreases in hospital visits, systemic steroid use and asthma medication use 1‐year after T&A, although these studies did not have control groups. Levin et al also demonstrated improvement in a marker of airway inflammation. Adenotonsillar hypertophy and inflammation may trigger inflammation in the lower airways that improves after T&A. Kheirnadish‐Gozal et al demonstrated significant improvements in acute asthma exacerbations, weekly β‐agonist rescue use and asthma symptom scores in poorly controlled asthmatics 1 year after T&A compared to untreated asthmatics without OSA.…”

“…24 Our results are similar to two uncontolled studies. Levin et al 10 demonstrated significant improvement in C-ACT scores six months after T&A with a median increase from 22 to 25 (P < 0.001) and…”

“…Levin et al demonstrated significant decreases in emergency room visits and oral corticosteroid courses 6 months after T&A and Busino et. al demonstrated significant decreases in hospital visits, systemic steroid use and asthma medication use 1‐year after T&A, although these studies did not have control groups.…”

“…Our results are similar to two uncontolled studies. Levin et al demonstrated significant improvement in C‐ACT scores six months after T&A with a median increase from 22 to 25 ( P < 0.001) and Busino et al demostrated signifcant improvements in C‐ACT scores in 93 asthmatic patients 1 year after T&A ( P < 0.01).…”

“…Data from 35 of the OSA children 1‐year after T&A was compared to 24 children without OSA and there was a significant decrease in asthma exacerbations (4.1 ± 1.3 to 1.8 ± 1.4/year, P < 0.0001) in the OSA children after T&A compared to no change in the non‐OSA children. Levin et al evaluated 66 children with asthma and 64 control children without asthma who underwent T&A. Mean asthma control test scores improved 6 months after surgery and there were significant reductions in the rates of emergency room visits, oral corticosteroid courses, missed days from school from asthma, total parental missed days of work due to illness and circulating chitinase activity in the asthmatic children.…”