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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