Limitations
Patients with preschool wheeze were offered the combined TA-B-BAL procedure only if they presented with severe wheeze and adenotonsillary hypertrophy or a history of recurrent tonsillar infection. The strict inclusion criteria and the concern of operative risk resulted in a small sample size. The small sample size was inadequate to appreciate differences in ICU and hospital admissions. These are rare events and a larger study sample is needed to evaluate this potential complication in preschool children with asthma. In addition, a longer follow up period would be ideal to monitor long term changes in asthma outcomes such as medication use and symptom control.
There are inherent limitations of a retrospective design such as lack of randomization of subjects and incomplete or missing data. The latter was evident with the TRACK questionnaires, as this tool was not implemented prior to 2014. As such, only 56% of patients completed the questionnaires both pre and post-procedure or treatment.
Conclusion
This exploratory study has provided subjective and objective evidence in support of a combined TA-B-BAL procedure to improve asthma control in preschool aged patients. Patients with a positive BAL were able to receive appropriate therapies to improve their symptoms. The combined TA-B-BAL procedure significantly reduced oral corticosteroid use and emergency department visits and lead to clinically meaningful improvements in TRACK scores. Although this is not a large study, there was sufficient experience to draw positive conclusions. Randomized control trials and prospective studies with larger sample size and longer follow up are required to better define the benefits of a TA-B-BAL procedure.
Acknowledgements: None to disclose
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