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Adenotonsillectomy and childhood asthma

PLOS

In an analysis of the 2003-2010 MarketScan US database, Rakesh Bhattacharjee and coauthors (University of Chicago, Chicago, Illinois) compared hospital admissions and prescriptions for children with asthma who underwent adenotonsillectomy before and after surgery to determine whether their asthma control improved (based on ICD-9-CM and CPT codes, as well as drug prescriptions) in the year after compared with the year before surgery. They also compared the children with children with asthma who did not undergo adenotonsillectomy who were the same age and sex and lived in the same region. Adenotonsillectomy is a surgical procedure most often used to treat symptoms of obstructive sleep apnea (OSA), when hypertrophy of upper airway adenotonsillar tissues obstructs breathing during sleep.

The authors identified 13,506 children with asthma who had undergone adenotonsillectomy and met their inclusion criteria. They matched these with 27,012 children with asthma who had not undergone adenotonsillectomy. They found that acute asthma exacerbations declined from 2243 before adenotonsillectomy to 1566 after, a much larger decline than occurred in children who did not undergo adenotonsillectomy. Episodes of acute status asthmaticus (severe, sustained asthma attacks) also declined, as did other measures including some asthma prescriptions, compared with children who did not undergo adenotonsillectomy. A limitation is that the MarketScan database does not include information on children with public health insurance (i.e., Medicaid) or uninsured children.

The authors say that the rationale of the study was "to examine whether the proposed overlap of two commonly inflammatory conditions in children, namely, asthma and OSA, leads to interdependent effects on the severity of the disease... current findings support the possibility that the presence of OSA aggravates underlying asthma in children, and that treatment of OSA (via [adenotonsillectomy]) might ameliorate the severity of asthma and reduce the need for more intensive use of anti-asthmatic medications. However, prospective trials are necessary to establish a causal relationship."

They conclude, "Further research is needed to better elucidate the pathways linking OSA with asthma in order to establish biological plausibility and, finally, to establish the criteria for identification of those children with asthma most likely to develop OSA and to potentially benefit from [adenotonsillectomy]."

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Research Article

Funding: Funding for this study was based exclusively using research development funds. RB is supported by AHA grant 13SDG14780079. DG is supported by National Institutes of Health grants HL-65270, HL-086662, and HL-107160. BM is supported by National Institutes of Health grant HL-119161. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Bhattacharjee R, Choi BH, Gozal D, Mokhlesi B (2014) Association of Adenotonsillectomy with Asthma Outcomes in Children: A Longitudinal Database Analysis. PLoS Med 11(11): e1001753. doi:10.1371/journal.pmed.1001753

Author Affiliations: University of Chicago, UNITED STATES

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Contact:

Rakesh Bhattacharjee
University of Chicago
UNITED STATES
+1 (773) 702-6178
rbhattac@bsd.uchicago.edu

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