Association of Adenotonsillectomy with Asthma Outcomes in Children: A Longitudinal Database Analysis
Association of Adenotonsillectomy with Asthma Outcomes in Children: A Longitudinal Database Analysis
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DOI：
10.1371/journal.pmed.1001753
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发表时间：
2014-11-01
期刊：
影响因子：
15.8
通讯作者：
Mokhlesi, Babak
中科院分区：
文献类型：
--
作者：
Bhattacharjee, Rakesh;Choi, Beatrix H.;Mokhlesi, Babak
背景资料：儿童哮喘和阻塞性睡眠呼吸暂停（OSA），这两种气道炎症疾病，在最近的观察性研究中相关。虽然腺样体扁桃体切除术（AT）能有效治疗儿童OSA，但AT是否也能改善儿童哮喘仍不清楚。我们假设，AT，一线治疗儿童OSA，将与改善哮喘的结果，并会减少使用哮喘治疗的children.Methods和Findings：使用2003-2010 MarketScan数据库，我们确定了13,506名儿童哮喘在美国谁接受AT。AT前1年的哮喘结果与AT后1年的结果进行比较。此外，纳入了27,012名年龄、性别和地理位置匹配的无AT的哮喘儿童，以检查无已知腺样体扁桃体组织发病率的儿童的哮喘结局。主要结局包括急性哮喘加重（AAE）或急性哮喘持续状态（阿萨）诊断代码的发生。次要结果包括哮喘药物处方的时间变化、哮喘相关急诊室就诊频率（ARERs）和哮喘相关住院（ARHs）。AT后一年与前一年相比，AT与AAE的显著减少相关（30.2%; 95% CI：25.6%-34.3%; p < 0.0001），阿萨（37.9%; 95% CI：29.2%-45.6%; p < 0.0001）、ARER（25.6%; 95% CI：16.9%-33.3%; p < 0.0001）和ARH（35.8%; 95% CI：19.6%-48.7%; p = 0.02）。此外，AT与大多数哮喘处方药（包括支气管扩张剂）的显著减少有关（16.7%; 95% CI：16.1%-17.3%; p < 0.001），吸入性皮质类固醇（21.5%; 95% CI：20.7%-22.3%; p < 0.001），白三烯受体拮抗剂（13.4%; 95% CI：12.9%-14.0%; p < 0.001）和全身性皮质类固醇（23.7%; 95% CI：20.9%-26.5%; p < 0.001）。相比之下，在重叠的随访期内，没有接受AT的哮喘儿童的这些结局没有显著降低。MarketScan数据库的局限性包括缺乏关于种族和肥胖状况的信息。此外，MarketScan数据库不包括有关享有公共医疗保险的儿童的信息（即，结论：在一个非常大的样本的私人保险的儿童，AT与显着改善几个哮喘的结果。通过前瞻性设计的临床试验验证，这项研究支持的前提是，检测和治疗腺样体组织的发病率可能作为一个重要的战略，以改善哮喘控制。
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.Methods and Findings: 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.