MIAMI BEACH — Adenotonsillectomy in children with asthma is associated with a significant improvement in their symptoms, Dr. David E. Karas reported in a poster presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
All of the children in Dr. Karas' prospective study received their surgery for usual indications, including chronic tonsillitis and obstructive sleep apnea. Nevertheless, by 1 year after their surgery, Dr. Karas said in an interview, many experienced significant decreases both in medication use and asthma severity, while their parents reported missing many fewer days of work to care for children during asthma exacerbations.
“We're not saying get a tonsillectomy if you have asthma,” said Dr. Karas, a pediatric otolaryngologist at Yale University, New Haven, Conn. “But it's clear that the surgery improves upper respiratory congestion and chronic sinusitis. When the upper airway is not doing well, that eventually takes a toll on the lower airway, and when we treat the upper airway, the lower airway can improve.”
He enrolled 31 patients aged 2–12 years who underwent adenoidectomy and/or tonsillectomy and had a diagnosis of asthma. Before the surgery, each caregiver filled out a questionnaire asking about medication use, asthma severity, and school and work days missed because of asthma exacerbation. Caregivers were contacted a mean of 1 year later and asked the same questions.
Medication use dropped significantly after surgery. The number of patients using inhaled steroids decreased from 25 to 14, albuterol from 30 to 18, and leukotriene moderators from 16 to 11. The single patient who was taking a long-acting β2-agonist before surgery was no longer taking it afterward.
The use of systemic steroids decreased as well. Before surgery, 22 patients used the drugs at least once a year; 8 required one course, 5 required two courses, 3 required three courses, and 6 required four courses. After surgery, only eight patients were using systemic steroids; all required one or two courses.
Caregivers also reported an average decrease from 2.0 to 0.81 in asthma severity symptom scores. All classes of asthma severity decreased: The number of children with severe persistent asthma declined from 4 to 0, with moderate persistent from 6 to 2, with mild persistent from 7 to 3, and with mild intermittent from 14 to 13. At the 1-year follow-up, 13 caregivers reported that their child had no asthma symptoms at all.
Of those children who attended school, the average number of missed school days per year decreased from 12.5 to 6. Caregivers' missed work days decreased as well, from 13 to 2 per year.
The relationship between upper airway infection and lower airway dysfunction may explain why some children with asthma experience exacerbations during winter and fall, when upper respiratory infections are more common, and why their symptoms improve with both oral corticosteroids and antibiotics, Dr. Karas said. “There's nothing that shrinks the tonsils like steroids—it's like you're giving a temporary medical tonsillectomy. And antibiotics treat the infective component by preventing those infected secretions that might be micro-aspirated and start up a reactive airway process.”
'We're not saying get a tonsillectomy if you have asthma.' But it's clear that it improves congestion. DR. KARAS