Asthma control in normal weight and overweight/obese asthmatic children following adenotonsillectomy

Gary D Josephson; Joshua B Bradshaw; Cheyenne Roohani; Jobayer Hossain; Steven M Andreoli; Jason E Lang

doi:10.1177/01455613221101085

Asthma control in normal weight and overweight/obese asthmatic children following adenotonsillectomy

Ear Nose Throat J. 2022 Dec 1:1455613221101085. doi: 10.1177/01455613221101085. Online ahead of print.

Authors

Gary D Josephson¹, Joshua B Bradshaw², Cheyenne Roohani², Jobayer Hossain³, Steven M Andreoli¹, Jason E Lang⁴

Affiliations

¹ Division of Pediatric Otolaryngology, Nemours Children's Health, Jacksonville, FL, USA.
² Department of Otolaryngology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
³ Bioinformatics Core Facility, Nemours Children's Health, Wilmington, DE, USA.
⁴ Division of Pulmonary and Sleep Medicine, Duke Children's Hospital and Health Center Duke University School of Medicine, Durham, NC, USA.

PMID: 36457155
DOI: 10.1177/01455613221101085

Abstract

Objectives: Childhood adenotonsillar hypertrophy (ATH) with sleep-disordered breathing (SDB) frequently occurs concomitant with asthma. Adenotonsillectomy and reduction in asthma severity association has been reported. We describe changes in asthma control in nonobese or normal weight and obese/overweight children undergoing adenotonsillectomy for SDB.

Methods: This prospective, nonrandomized cohort trial with 6-month follow-up at a tertiary children's hospital enrolled 41 children with persistent asthma undergoing adenotonsillectomy for SDB. Children with significant chronic medical conditions, premature birth (< 28 weeks), or recent respiratory infection were excluded. Patients were stratified by baseline BMI into nonobese or normal weight (BMI < 85 percentile) and obese/overweight (BMI > 85%). The primary outcome was change in Childhood Asthma Control Test (cACT) scores 3 and 6 months following adenotonsillectomy. Secondary outcome examined improvement in Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) 3 and 6 months following adenotonsillectomy.

Results: Baseline characteristics were similar except for anthropometric measures and mean PACQLQ (P = .03). Children with nonobese or normal weight (n = 26) had statistically significant improvement in change in cACT at 3 (22.80 ± 2.33 vs. 17.86 ± 3.53, P < .001) and 6 (20.71±3.29 vs. 18.24 ± 4.16, P = .044) months compared with baseline. PACQLQ scores also improved at 3 (6.20 ± 0.87 vs. 4.56 ± 1.12, P < .001) and 6 (6.36 ± 0.72 vs. 4.93 ± 0.96, P < .001) months. Obese/overweight children (n = 10) had significant improvement in cACT scores at 6 months (20.00 ± 3.90 vs. 15.00 ± 6.90, P = .048). Change of cACT scores at 3 months (17.86 ± 3.53 vs. 14.86 ± 6.31, P = .272) was not significantly different. PACQLQ scores improved at 3 (5.47 ± 1.09 vs. 3.70 ± 0.85, P < .001) and 6 (5.75 ± 2.19 vs. 3.67 ± 1.04, P = .016) months.

Conclusion: Nonobese or normal-weight children undergoing adenotonsillectomy demonstrated significant improvement in asthma control scores at 3 and 6 and obese/overweight children at 6 months. Using the PACQLQ, caregiver quality of life improved for all children at 3 and 6 months. Surgical management of ATH in children with comorbid SBD and asthma is a good treatment option.

Keywords: adenotonsillar hypertrophy; adenotonsillectomy; asthma; children; sleep-disordered breathing.