title: Association of adenotonsillectomy with asthma outcomes in children: a longitudinal database analysis.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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<0.0001), ASA (37.9%; 95% CI: 29.2%-45.6%; p<0.0001), ARERs (25.6%; 95% CI: 16.9%-33.3%; p<0.0001), and ARHs (35.8%; 95% CI: 19.6%-48.7%; p = 0.02). Moreover, AT was associated with significant reductions in most asthma prescription refills, including bronchodilators (16.7%; 95% CI: 16.1%-17.3%; p<0.001), inhaled corticosteroids (21.5%; 95% CI: 20.7%-22.3%; p<0.001), leukotriene receptor antagonists (13.4%; 95% CI: 12.9%-14.0%; p<0.001), and systemic corticosteroids (23.7%; 95% CI: 20.9%-26.5%; p<0.001). In contrast, there were no significant reductions in these outcomes in children with asthma who did not undergo AT over an overlapping follow-up period. Limitations of the MarketScan database include lack of information on race and obesity status. Also, the MarketScan database does not include information on children with public health insurance (i.e., Medicaid) or uninsured children.
  
  
  CONCLUSIONS
  In a very large sample of privately insured children, AT was associated with significant improvements in several asthma outcomes. Contingent on validation through prospectively designed clinical trials, this study supports the premise that detection and treatment of adenotonsillar tissue morbidity may serve as an important strategy for improving asthma control. Please see later in the article for the Editors' Summary.
authors.affiliation: Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Bhattacharjee
authors.affiliation: Center for Health and Social Sciences, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Beatrix H
authors.initials: BH
authors.lastname: Choi
authors.affiliation: Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.affiliation: Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery; D014068:Tonsillectomy
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D020024:Leukotriene Antagonists