If your child has to undergo a tonsillectomy, there is important research newly published in JAMA Pediatrics that I’d like to share with you today. It’s called The REACT Randomized Clinical Trial.
About 30 years ago, 90% of tonsillectomies performed on children were because of persistent, recurrent infections. Today, it’s more like 20% for infections and 80% for obstructive sleep problems/breathing.
So the reason for this surgical procedure varies, but it could have something to do with infections, persistent inflammation of the tonsils and difficulty breathing during seep. The latter is termed “sleep-disorded breathing” or SDB and symptoms that your child may have vary but often include shortness of breath, wheezing, coughing or bronchospasm.
In adults, breathing difficulties occur during sleep and are quite uncomfortable and scary. The symptoms of SDB range from loud snoring, to complete blockage of the breathing airways (during sleep) termed sleep apnea, or obstructive sleep apnea. A CPAP device is best for that, and naturally, routine visits to your ENT doctor. In children, tonsillectomies are common surgical procedures and not considered high risk. Unfortunately, half of the children experience a problem during or right after the procedure that has to do with their lungs, ability to breathe with comfort and other symptoms. You can see in the graphic below, the difference between abnormal and normal tonsils.
For example, tonsillectomies can frequently cause problems ranging from coughing, bronchospasm, laryngospasm and airway obstruction to oxygen reductions in the blood, coughing, and stridor, the term for wheezing which occurs due to a blocked windpipe or larynx. These symptoms are extremely frightening for both the child, and the doctor, not to mention the parents if are present during an episode. My hope today is that my information allows your child to get through the procedures without these terrifying problems.
Researchers conducted a study to see if they could help kids and get to the bottom of all of this. So they gave half the study participants 2 puffs (200 mcg) of a popular asthma drug called albuterol. The other half received a placebo, meaning a non-medicinal inhalation. The experts wanted to see if the asthma drug could serve as a pre-treatment drug to lower the risk of children experiencing peri-operative breathing difficulties during their tonsillectomy.
Sure enough, it helped, just 2 actuations of albuterol administered via inhalation and taken shortly before anesthesia (and before the surgical procedure) could help reduce the risk of these adverse events that surround tonsillectomies. The placebo group experienced a lot of breathing problems, almost half of those kids had an issue. In the albuterol-treated group, only 28 percent of kids had an issue. This is quite significant. The research published in JAMA Pediatrics concluded “Premedication with albuterol should be considered for children undergoing tonsillectomy.”
If you are the parent of a child that requires a tonsillectomy be sure to tell your doctor about this research, don’t assume they know it because it just got published literally days ago.
It also begs the question if albuterol (which is cheap and easy to get by prescription) could be helpful for other people with breathing difficulties, such as apnea. The answer is no. There isn’t any clinical evidence to support the use of this asthma drug for apnea, or loud snoring, and in fact, albuterol is stimulating, and it may interfere with restful sleep. Albuterol is a quick-relief inhaler designed primarily for asthma as a rescue aid. It’s not an apnea drug. If you have apnea, use a CPAP device. In summary, new research suggests a beautiful new use for albuterol during tonsillectomies as an aid to reduce breathing difficulties related to anesthesia and the procedure itself.
Albuterol is sold in the US by prescription at pharmacies nationwide, and of course, it is administered in the hospital when there is an order for the patient.