Improvement in asthma control and inflammation in children undergoing adenotonsillectomy.
BACKGROUND
Observational studies suggest that asthma control improves after adenotonsillectomy, but longitudinal studies that correlate the effect of the procedure on the levels of biomarkers associated with airway inflammation are limited.


METHODS
We conducted a longitudinal, observational study on pediatric patients, both with and without asthma, undergoing adenotonsillectomy. Asthma control test (ACT) scores and chitinase activity in the circulation were measured at time of surgery and at 6-mo follow-up.


RESULTS
Sixty-six children with asthma and 64 control subjects were enrolled. Mean ACT scores improved by three points (P < 0.001) after 6 mo. 85% of children with poorly controlled asthma demonstrated an increase in ACT score of at least three points or a decrease in emergency department/urgent care visits, oral corticosteroid courses, or rescue short acting bronchodilator usage. Chitinase activity decreased significantly in asthmatics who improved (P < 0.01). Higher chitinase activity levels at baseline were associated with improved asthma control following surgery (P < 0.01).


CONCLUSIONS
In children with high preoperative circulating chitinase activity levels, asthma control and healthcare utilization were significantly improved after adenotonsillecotmy. Chitinase activity decreased after surgery in children with improved control. This suggests that adenotonsillectomy modulates chitinase activity, affecting airway inflammation and improving airway disease.
Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, Connecticut.
Jonathan C
JC
Levin
Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
Lisa
L
Gagnon
Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, Connecticut.
Xiaoxuan
X
He
Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
Eric D
ED
Baum
Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
David E
DE
Karas
Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, Connecticut.
Geoffrey L
GL
Chupp
D000233:Adenoidectomy; D000293:Adolescent; D001249:Asthma / Q000503:physiopathology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D002688:Chitinases / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005470:Fluorometry; D006801:Humans; D008137:Longitudinal Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014068:Tonsillectomy
D002688:Chitinases