Sleep Apnea Procedure May Improve Childhood Asthma

Asthma attacks decreased in children who underwent adenotonsillectomy

(RxWiki News) Asthma attacks can be stressful health scares for both children and their parents. But new research shows that a sleep disorder treatment could offer relief.

A recent study looked at children with asthma who had their tonsils and adenoids removed — a common treatment for sleep apnea.

In the year following the operation, those children had fewer asthma attacks and asthma-related hospital visits than in the year prior.

The researchers suggested that the sleep apnea procedure could improve asthma conditions for children.

"Tonsillectomy is never performed (to my knowledge) with the idea of helping asthma, but rather, to help symptoms caused by enlarged and sometimes infected tonsils and adenoid tissue that affect the upper airway," said Mark Millard, MD, Medical Director of the Martha Foster Lung Care Center at Baylor University Medical Center at Dallas.

"Indeed, the authors suspected that the bulk of surgical procedures were performed to relieve the symptoms of obstructive sleep apnea, what they appeared to be really interested in, and whether improving obstructive sleep apnea would help asthma," said Dr. Millard, who was not involved in this study.

Rakesh Bhattacharjee, MD, of the Department of Pediatrics at University of Chicago, led the research.

Asthma is one of the most common diseases in children. It occurs when the airways become inflamed and narrow, leading to trouble breathing.

Recent studies have shown that many children with asthma also have sleep apnea, the study authors noted. Patients with sleep apnea experience shallow or paused breathing during sleep.

"Several small studies have described a strong association between obstructive sleep apnea and asthma, two common inflammatory conditions that impair breathing in children," Dr. Bhattacharjee said in a press statement.

Adenotonsillectomy (AT), a procedure to remove the tonsils and adenoids — lumps of tissue in the throat — is often used to treat sleep apnea. These lumps of tissue often become inflamed and swell in sleep apnea patients, which can make breathing more difficult. The tonsils and adenoids are a part of the immune system, but the immune system isn't harmed when they're removed.

This study examined more than 13,000 children with asthma who underwent AT. The researchers compared the children's health outcomes to a control group of more than 27,000 children with asthma who didn't have their tonsils and adenoids removed.

They found that children who underwent AT had 30 percent fewer asthma attacks in the year following their surgery than they did the year before. During the same time period, the control group had only a 2 percent drop in asthma attacks.

Also, kids who had the surgery had fewer instances of wheezing — a common symptom of asthma — than kids who did not undergo AT, the authors found.

"In this large, observational trial, there clearly seemed to be an improvement of asthma-related illness and outcomes, but there are always more questions raised when this kind of association is recognized," Dr. Millard told dailyRx News.

"For one thing, unless you have objective measurements of lung function, it is very difficult to determine when the problem is asthma or worsening upper airway obstruction — both of which present with increasing cough, shortness of breath and wheezing," Dr. Millard said. "Unless you have spirometry [common lung function test] to measure airflow obstruction or exhaled nitric oxide that measures airway inflammation, you really may not know what you are really dealing with. This study relied upon a physician’s diagnosis of asthma, in a time period when and in a population where spirometry was infrequently performed."

Dr. Bhattacharjee and colleagues concluded that AT improved asthma outcomes in children.

According to Dr. Millard, "This study does show that performing [adenotonsillectomy] in young people with significant tonsillar disease causing obstruction and asthma may improve symptoms of asthma control, but in the absence of upper airway obstruction, the conclusion that surgery on tonsils will improve asthma is certainly unwarranted."

He added, "My personal feeling is that many people with a diagnosis of asthma often have significant upper airway disease causing symptoms that mimic asthma. If you take care of the upper tract problem, of course symptoms will improve, and that may have nothing to do with asthma."

This study was published Nov. 4 in PLOS Medicine.

Grants from the National Institutes of Health and the American Heart Association funded the research. The authors disclosed no conflicts of interest.

Review Date: 
November 4, 2014