Adenotonsillectomy for OSA Improves Asthma in Kids

By Anne Harding

November 06, 2014

NEW YORK (Reuters Health) - Children with asthma who undergo adenotonsillectomy (AT) show significant improvements in several measures of disease severity, a study in more than 40,000 children demonstrates.

Two other studies, each in fewer than 100 children, have linked AT to better asthma outcomes. The current study is unique both in its size, its geographical spread and the fact that it extended over two years, given that asthma severity can vary seasonally, said Dr. Rakesh Bhattacharjee of the University of Chicago, the study's first author, in a telephone interview.

Both obstructive sleep apnea (OSA) - the most common indication for AT - and asthma are characterized by airway inflammation, Dr. Bhattacharjee and his colleagues note in their report, published November 4 in PLoS Medicine. Recent observational studies have linked OSA to asthma, the researchers add, but it is not clear what impact AT has on asthma symptoms.

To investigate, the researchers compared 13,506 children with asthma who underwent AT to 27,012 age-, sex- and geographically matched controls, who also had asthma but did not undergo AT. They used 2003-2010 data from MarketScan, a database including more than 180 million privately insured patients.

Dr. Bhattacharjee and his team looked at asthma outcomes for one year before and one year after AT in the study group, comparing them to outcomes for the control group over the same time period.

AT reduced the likelihood of the two primary outcomes, acute asthma exacerbations (AAE) and acute status asthmaticus (ASA) by 30.2% and 37.9%, respectively (both p<0.0001). Asthma-related emergency room visits were reduced by 25.6% after AT, while asthma-related hospitalizations fell by 35.8%.

Patients also had significantly fewer refills of several asthma medications after AT. Refills of bronchodilators were 16.7% lower, inhaled corticosteroids dropped by 21.5%, leukotriene receptor antagonists fell by 13.4%, and systemic corticosteroids dropped by 23.7%.

There were no significant reductions in any of the outcomes measured among the children with asthma but no apparent need for AT over the overlapping time period.

The children with asthma and OSA had more severe symptoms than their control-group peers, but their symptom levels after AT were comparable to those of the control group, Dr. Bhattacharjee noted. Physicians who treat asthma in children should investigate whether a patient has any morbidity related to adenotonsillar tissue hypertrophy, he added.

"If there is an asthmatic child that has snoring and possibly obstructive sleep apnea, that child's asthma can improve if you treat their obstructive sleep apnea through adenotonsillectomy," he said.

While a prospective randomized trial of AT for children with asthma and OSA would be the "ideal" next step, actually doing such a study would be difficult, the researcher added, especially one that followed children for an entire year.

Dr. Bhattacharjee and his colleagues are currently searching for inflammatory mediators that could link both OSA and asthma. "That would at least support biological plausibility," he said.


PLoS Medicine 2014.


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