Morphofunctional changes following adenotonsillectomy of obstructive sleep apnea children: a case series analysis.

OBJECTIVE: To perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA). MATERIALS AND METHODS: Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1). RESULTS: PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients. CONCLUSION: Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.

Impact of an asthma management program on hospitalizations and emergency department visits.

OBJECTIVES: To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrollment in an asthma program. METHODS: Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrollment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment. RESULTS: In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000). CONCLUSIONS: Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.

Impacto de um programa de manejo da asma sobre as hospitalizações e os atendimentos de urgência / Impact of an asthma management program on hospitalizations and emergency department visits

OBJETIVOS: Analisar as frequências de hospitalização e de atendimentos em serviços de urgência ocorridas em crianças e adolescentes antes e após o ingresso em programa de asma no Brasil. MÉTODOS: Prontuários de 608 pacientes menores de 15 anos e com asma foram avaliados retrospectivamente. As frequências de hospitalização por asma e de atendimentos em serviços de urgência para episódios agudos de broncoespasmo foram avaliadas nos períodos anterior e posterior à admissão no programa que disponibiliza medicamentos, preconiza abordagem integral do paciente e manejo profilático de acordo com a Global Initiative for Asthma (GINA). O período de observação antes do programa (AP) teve a duração de 12 meses enquanto o depois do programa (DP) variou de 12 a 36 meses. RESULTADOS: No período AP, ocorreram 895 hospitalizações e 5.375 atendimentos em serviços de urgência, e no período DP, ocorreram 180 hospitalizações e 713 atendimentos na urgência. O teste t de Student para amostras pareadas e o modelo de regressão para observações dependentes identificaram efeito significativo do programa em relação às variáveis estudadas (p = 0,000). CONCLUSÕES: A adoção das recomendações do GINA levou à redução significativa nas frequências de hospitalização e atendimentos na urgência em crianças e adolescentes com asma.

OBJECTIVES: To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrolment in an asthma program. METHODS: Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrolment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment. RESULTS: In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000). CONCLUSIONS: Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.