Changes in sensitization rates in patients with asthma and/or rhinitis in China between 2008 and 2018: a national cross-sectional studyWanjun Wang1*, Jianhong Wang2*, Guihua Song3*, Hua Xie4*, Xiaoping Lin4*, Ruonan Chai4*, Rongfei Zhu5*, Yong He6*, Jun Tang7*, Junge Wang8*, Jinghua Yang9*, Lili Zhi10*, Lin Wu11*, Yan Jiang12*, Xiaoqin Zhou13*, Dongming Huang14*, Ning Wang15*, Rui Xu16*, Yuan Gao17*, Zhimin Chen18*, Jinling Liu18*, Xiaoli Han19*, Guolin Tan20*, Jinzhun Wu21*, Deyu Zhao22*, Jianjun Chen23*, Xiwei Zhang24*, Mengrong Li24*, Yuemei Sun25*, Yi Jiang26*, Weitian Zhang27*, Qianhui Qiu28*, Chuanhe Liu29*, Jie Yin30*, Guodong Hao31*, Huabin Li32*, Yongsheng Xu33*, Shaohua Chen34*, Hua Zhang35, Shi Chen36, Juan Meng37, Dan Zeng38, Wei Tang39, Chuangli Hao40, Jing Li1†, Nanshan Zhong1†, for the China Alliance of Research on Respiratory Allergic Disease*Contributed equally†Joint corresponding authors1 National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University;2 The First People’s Hospital of Yibin, Sichuan;3 The First Affiliated Hospital of Henan University of Traditional Chinese Medicine;4 General Hospital of Northern Theater Command;5 Tongji Hospital, Tongji Medical College, Huazhong University of Science&Technology;6 The Affiliated Hospital of Medical School, Ningbo University;7 Foshan First people’s hospital;8 Beijing Hospital of Traditional Chinese Medicine;9 GuangDong Provincial Hospital of Chinese Medicine;10 The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases;11 Hangzhou Hospital of Traditional Chinese;12 The Affiliated Hospital of Qingdao University;13 Hubei Province Maternal and Child Health Hospital;14 Boai Hospital of Zhongshan City;15 Xi’an Children’s Hospital;16 The First Affiliated Hospital of Sun-Yat University;17 The First Affiliated Hospital of Zhengzhou University;18 Children’s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health;19 Hebei General Hospital;20 Third Xiangya Hospital of Central South University;21 The Women and Children’s Hospital affiliated to Xiamen University;22 Children’s Hospital of Nanjing Medical University;23 Union hospital of Tongji medical college;24 The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University;25 Yu Huang Ding Hospital;26 The First Hospital of Shanxi Medical University;27 Shanghai Jiao Tong University Affiliated Sixth People’s Hospital;28 Zhujiang Hospital of Southern Medical University;29 Children’s Hospital Capital Institute of Pediatrics;30 Chengdu First People’s Hospital;31 Tangshan Gongren Hospital;32 ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University;33 Children’s Hospital of Tianjin University;34 Guangdong Provincial People’s Hospital;35 The First Affiliated Hospital of Xinjiang Medical University;36 Hainan provincial people’s Hospital;37 West China Hospital of Sichuan University;38 Chongqing General Hospital, University of Chinese Academy of Sciences;39 Ruijin Hospital of Shanghai Jiaotong University;40 Children’s Hospital of Soochow University.

Objectives: To establish an optimized airway management process to improve preoperative lung dysfunction in obstructive sleep apnea (OSA). Design: A retrospective case series study Setting: Tertiary university hospital in China Participants: The study included 483 children (319 males and 164 females; 6y to14y years) with OSA who underwent an adenotonsillectomy from November 2017 to December 2018. Main outcome measures: Children with OSA and who had abnormal airway function were identified by lung function test, and the risk factors for abnormal lung function were assessed. Next, the children received individualized atomization intervention based on the severity of their abnormal lung function, and the improvement in lung function was evaluated. Results: Lung function tests revealed that 45 patients had obstructive ventilation dysfunction, and histories of chronic cough or asthma were identified as risk factors for perioperative abnormal lung function. The FEV1% pre exceeded 80% after 2 days of atomization intervention in 27 of 28 mild cases, 4 of 13 moderate cases, but in none of the 4 moderate-severe cases. After 4 days of atomization intervention, the FEV1%pre of the remaining 14 patients in the three groups all increased up to 80%. Other indicators of lung function (e.g., FEV1/FVC% pre, MEF50% pre, MEF25% pre, and MMEF% pre) were also greatly improved following the improvement of FEV1% pre. No perioperative airway complications occurred. Conclusion: Prior to performing surgery on children with OSA and who have risk factors associated with abnormal lung function, it is potentially beneficial to establish an optimized airway management process to improve lung function before adenotonsillectomy. Keywords: Children, obstructive sleep apnea, airway management, lung function, surgical risk