Investigators: Elizabeth Smith, Graham Hall, Sherlynn Ang
Asthma is characterised by recurrent respiratory symptoms, airway inflammation and increased airway reactivity. Australia has one of the highest rates of asthma in the world. In Western Australia, approximately 25% of children presenting for surgery have respiratory symptoms. These hallmark characteristics of asthma particularly in children, are driving factors for respiratory complications during and after surgery under general anaesthesia (perioperative period) with significant impact on patient safety, increased burden on their family and increased use of healthcare resources. Current clinical practice in the assessment of the perioperative risk of respiratory complications does not include objective assessments of airway inflammation.
Our study proposes to measure the presence of airway inflammation using noninvasive methods in the Doctor’s rooms and compared to routine clinical care, assess whether pre-operative treatment with inhaled corticosteroids (ICS) will decrease the occurrence of perioperative respiratory complications in children with respiratory symptoms and airway inflammation. Children aged between 4 to 10 years presenting for tonsillectomy with respiratory symptoms and confirmed airway inflammation will either receive routine clinical care or a 14-day course of ICS. We expect to observe a significant decrease in the rate of perioperative respiratory complications and hospital stays in the ICS group.
This pilot trial will generate preliminary, evidence-based results and inform the design of a multicentre, Australian-based study, for improved clinical management of these children prior to surgery including screening for airway inflammation and where required, pre-treatment with ICS leading to significant reductions in healthcare utilisation and increased cost savings.
External collaborators:
- Shyan Vijayasekaran, Britta Regli-Von Ungern-Sternberg, David Sommerfield, Hayley Herbert (Perth Children's Hospital)
- Elizabeth Geelhoed, Paul Bumbak (University of Western Australia)