loading page

Adenotonsillectomy, Bronchoscopy and Bronchoalveolar Lavage in the Management of Preschool Children with Severe Asthma
  • +4
  • Emma Campisi,
  • Myrtha Vargas,
  • May Brydges,
  • Aimee Dubeau,
  • Theo Moraes,
  • Paolo Campisi ,
  • Padmaja Subbarao
Emma Campisi
The Hospital for Sick Children
Author Profile
Myrtha Vargas
The Hospital for Sick Children
Author Profile
May Brydges
The Hospital for Sick Children
Author Profile
Aimee Dubeau
Hospital for Sick Children
Author Profile
Theo Moraes
Hospital for Sick Children
Author Profile
Paolo Campisi
The Hospital for Sick Children
Author Profile
Padmaja Subbarao
Hospital for Sick Children
Author Profile

Abstract

Objective: The potential benefit of a combined adenotonsillectomy and bronchoscopy with bronchoalveolar lavage (TA-B-BAL) in preschool children with asthma has been debated in the literature. We aimed to describe the clinical course of preschool children with severe asthma undergoing this combined procedure. Study Design: This is a retrospective case-control study. Patient Selection: Preschool patients diagnosed with severe asthma who underwent TA-B-BAL treatment between 2012 and 2019 were included as cases. Controls were age and sex matched patients receiving standard asthma care. Methodology: A retrospective patient chart review was conducted. Data on demographics, clinical characteristics, medication use, virology and microbiology from bronchoalveolar lavage, and asthma control questionnaires were collected. Cases and controls were compared with t-tests and regression analysis. Results: Eighteen preschool subjects (mean age 3.19±1.13 years) in the case group were matched to eighteen control subjects receiving standard care. A Poisson mixed effects regression analysis revealed reduced risk of oral corticosteroid use (RR 0.39, 95%CI 0.18, 0.83, p=0.014), reduced emergency department visits (RR 0.36, 95%CI 0.17, 0.75, p=0.01) and reduced risk of asthma exacerbations (RR 0.58, 95%CI 0.28, 1.20, p=0.14) in cases compared to controls. Ten patients experienced clinically meaningful improvements in TRACK scores after the procedure (p<0.001). Conclusion: This pilot study provides early evidence that preschool children with severe asthma may benefit from combined adenotonsillectomy and bronchoscopy with bronchoalveolar lavage procedure. The procedure is a useful adjunct for reduction of medication use and hospital visits for preschool age patients with severe asthma.