Association of adenotonsillectomy with asthma outcomes in children: a longitudinal database analysis

Childhood asthma and obstructive sleep apnea (OSA), both disorders of airway inflammation, were associated in recent observational studies. Although childhood OSA is effectively treated by adenotonsillectomy (AT), it remains unclear whether AT also improves childhood asthma. We hypothesized that AT,...

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Bibliographic Details
Published in:PLoS medicine 2014-11, Vol.11 (11), p.e1001753-e1001753
Main Authors: Bhattacharjee, Rakesh, Choi, Beatrix H, Gozal, David, Mokhlesi, Babak
Format: Article
Language:English
Subjects:
Adenoidectomy
Adolescent
Adrenal Cortex Hormones - therapeutic use
Age
Asthma
Asthma - complications
Asthma - drug therapy
Asthma - surgery
Bronchodilator Agents - therapeutic use
Case-Control Studies
Child
Child, Preschool
Children
Chronic illnesses
Databases, Factual
Emergency medical care
Female
Health aspects
Hospitalization
Humans
Leukotriene Antagonists - therapeutic use
Longitudinal Studies
Male
Medicine and Health Sciences
Physiological aspects
Sleep
Sleep apnea
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - surgery
Studies
Tonsillectomy
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Summary:Childhood asthma and obstructive sleep apnea (OSA), both disorders of airway inflammation, were associated in recent observational studies. Although childhood OSA is effectively treated by adenotonsillectomy (AT), it remains unclear whether AT also improves childhood asthma. We hypothesized that AT, the first line of therapy for childhood OSA, would be associated with improved asthma outcomes and would reduce the usage of asthma therapies in children. Using the 2003-2010 MarketScan database, we identified 13,506 children with asthma in the United States who underwent AT. Asthma outcomes during 1 y preceding AT were compared to those during 1 y following AT. In addition, 27,012 age-, sex-, and geographically matched children with asthma without AT were included to examine asthma outcomes among children without known adenotonsillar tissue morbidity. Primary outcomes included the occurrence of a diagnostic code for acute asthma exacerbation (AAE) or acute status asthmaticus (ASA). Secondary outcomes included temporal changes in asthma medication prescriptions, the frequency of asthma-related emergency room visits (ARERs), and asthma-related hospitalizations (ARHs). Comparing the year following AT to the year prior, AT was associated with significant reductions in AAE (30.2%; 95% CI: 25.6%-34.3%; p
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001753