Adenotonsillectomy and childhood asthma

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]."