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Adenotonsillectomy, bronchoscopy and bronchoalveolar lavage in the management of preschool children with severe asthma: pilot study

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

This is a pilot study that describes the feasibility and clinical course of a cohort of preschool children with severe asthma undergoing a combined adenotonillectomy (TA), bronchoscopy (B), and bronchoalveolar lavage (BAL) procedure.

Methods

A retrospective cohort study of preschool patients with severe asthma who underwent a combined TA-B-BAL procedure between 2012 and 2019. Subjects were treated at a tertiary care asthma clinic and had a diagnosis of preschool asthma according to the Canadian Thoracic Society Guidelines. Data on demographics, clinical characteristics, medication use, virology and microbiology from bronchoalveolar lavage, and asthma control questionnaires were collected. Variables were analyzed using paired t test.

Results

Eighteen preschool subjects (mean age 3.19 ± 1.13 years) with severe asthma were identified through the asthma clinic. Patients treated with standard asthma care and a combined  TA-B-BAL procedure  experienced a decrease in the number of oral steroid courses (p = 0.017), emergency department visits (p = 0.03) and wheezing exacerbations (p = 0.026) following the procedure. Ten patients experienced clinically meaningful improvements in TRACK scores after the procedure (p < 0.001).

Conclusion

This pilot study provides early evidence that a combined TA-B-BAL procedure is feasible in preschool children with severe asthma and that the procedure may reduce asthma medication use and hospital visits.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Emma S. Campisi & Paolo Campisi

  2. Division of Respiratory Medicine, Department of Paediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada

    Myrtha E. Reyna, May Brydges, Aimee Dubeau, Theo J. Moraes & Padmaja Subbarao

  3. Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, 27 King’s College Circle, Toronto, Canada

    Padmaja Subbarao

Authors
  1. Emma S. Campisi
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  2. Myrtha E. Reyna
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  3. May Brydges
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  4. Aimee Dubeau
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  5. Theo J. Moraes
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  6. Paolo Campisi
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  7. Padmaja Subbarao
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Contributions

Conceptualization: ESC, PC, PS; methodology: ESC, MER, MB, AD, TJM, PC, PS; formal analysis and investigation: ESC, MER; writing—original draft preparation: ESC, MER; writing—review and editing: ESC, MER, MB, AD, TJM, PC, PS; supervision: PC, PS.

Corresponding author

Correspondence to Paolo Campisi.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

The study was reviewed by the institutional Research Ethics Board at the Hospital for Sick Children (REB# 1000069481, April 19, 2020). This study was conducted retrospectively from data obtained from clinical purposes.

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Campisi, E.S., Reyna, M.E., Brydges, M. et al. Adenotonsillectomy, bronchoscopy and bronchoalveolar lavage in the management of preschool children with severe asthma: pilot study. Eur Arch Otorhinolaryngol 279, 319–326 (2022). https://doi.org/10.1007/s00405-021-07084-x

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  • DOI: https://doi.org/10.1007/s00405-021-07084-x

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