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Adenotonsillectomy improved asthma symptoms.

ORLANDO -- Children with asthma who underwent adenotonsillectomies showed significant improvement in their asthma symptoms, compared with presurgical levels, according to findings from a retrospective study of 93 children with asthma.

Children with asthma are at greater risk for sleep-disordered breathing than their peers without asthma, said Dr. Rowley S. Busino of the University of Medicine and Dentistry of New Jersey, Newark. Consequently, asthma is a common comorbidity in children undergoing adenotonsillectomy.

Parents of children with asthma often report that their children's asthmatic symptoms improve after an adenotonsillectomy, but that observation has not been well studied, Dr. Busino observed.

Dr. Busino and her colleagues reviewed data from all children who underwent adenotonsillectomy at a single institution between 2002 and 2007. The study population included 93 children with asthma and 372 children without asthma. The children were aged 3-14 years, with an average age of 6 years. Children younger than 3 years and those with comorbid medical conditions including Down syndrome, heart disease, subglottic stenosis, prematurity, and neurologic disorders were excluded. Both groups were similar in terms of age and sex distribution, and the most common reason for surgery in both groups was obstructive sleep apnea/adenotonsillar hypertrophy. Asthma symptoms were assessed 12 months before and 12 months after surgery.

After surgery, the children with asthma had significantly fewer hospital visits (1.6 vs. 0.1), and used significantly fewer daily medications (2.6 vs. 2.3) and systemic steroids (2.0 vs. 0.5), compared with presurgery levels.

Scores on the Asthma Control Test also improved significantly after surgery, compared with presurgery scores, from 18.5 to 20.5, Dr. Busino reported in a poster at the meeting.

Because of the small number of respiratory complications in each group, the researchers were not able to assess whether children with asthma had a higher postoperative respiratory complication rate, compared with children without asthma. The average length of postoperative hospital stay was not significantly different between the asthma and control groups.

"This study suggests that adenotonsillectomy, which provides improvement in the upper airways of children, may in turn lead to improvement of their lower airways," Dr. Busino said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

Prospective studies to clarify the relationship between asthma, adenotonsillectomy, and obstructive sleep apnea are needed to improve clinical care, Dr. Busino said.


Major Finding: Children with asthma who underwent adenotonsillectomies required significantly less asthma medication and had fewer hospitalizations, compared with presurgical utilization.

Data Source: A retrospective study of 465 consecutive children with and without asthma who underwent adenotonsillectomy at a single institution. Symptoms of asthma were compared 12 months before and after surgery.

Disclosures: None was reported.



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Title Annotation:CLINICAL ROUNDS
Author:Splete, Heidi
Publication:Pediatric News
Date:Jul 1, 2010
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