Author

Maria Koenigs

Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Geoffrey L. Chupp

Subject Area(s)

Medicine, Surgery

Abstract

Recent small observational studies suggest that asthmatic children receive clinical benefit in asthma control following adenotonsillectomy (TA), but little is known about which clinical and biological characteristics impact improvement. We enrolled 213 children undergoing TA, including 136 children with asthma and 78 controls, in a longitudinal observational cohort study (YCAAD). An asthma questionnaire, Asthma Control Test (ACT) scores, and serum asthma biomarkers levels were obtained at baseline and at six-months. Interim analysis compared patient characteristics to a historical cohort (CT-Kids) of 49 children with asthma who underwent TA. Urgent care visits (P < 0.001), oral steroid courses (P < 0.001), and ACT scores (P < 0.001) all improved in children with asthma following TA. Serum Th2 inflammatory markers, including IL-4 (P = 0.022) and IL-5 (P = 0.002), decreased following TA. Decreased IL-5 levels following surgery correlated with improvement in urgent care visits (P = 0.021), decreases in oral steroids (P = 0.02), and overall improvement in asthma control (P = 0.008). Children who were low or healthy weight, younger, female, had a history of sinusitis, and/or had a history of persistent asthma were more likely have improvement in their asthma following surgery. Elevations of serum IL-2, IL-4, IL-5, IL-13, IFN-γ, TNF-α, and GM-CSF levels were found in children whose asthma improved after TA. These clinical characteristics and biomarkers may help predict which children will receive maximum benefit in asthma control following TA.

Comments

This is an Open Access Thesis.

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