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Inhaled Corticosteroids Use Before Hospitalization May Be Protective in Children With Direct Lung Injury

Year: 2024

Type: article

Abstract: Background Systemic corticosteroid use in acute respiratory failure has yielded uncertain benefits, partially because of off-target side effects. Inhaled corticosteroids (ICSs) confer localized antiinflammatory benefits and may protect adults with direct lung injury (DLI) from developing respiratory failure. To our knowledge, this relationship has not been studied in children. Research Question Do children with DLI who are prescribed ICSs before hospitalization have lower odds of progressing to respiratory failure? Study Design and Methods This retrospective, single-center cohort identified children seeking treatment at the ED with DLI and medication records before hospitalization. The primary outcome was intubation; secondary outcomes included noninvasive respiratory support (NRS). We tested the association of ICSs with intubation and NRS, adjusting for confounders. We stratified analyses on history of asthma and performed a sensitivity analysis adjusting for systemic corticosteroid use to account for status asthmaticus. Results Of 35,220 patients, 17,649 patients (50%) were prescribed ICSs. Intubation occurred in 169 patients (73 patients receiving ICSs) and NRS was used in 3,582 patients (1,336 patients receiving ICS). ICS use was associated with lower intubation (adjusted OR, 0.46; 95% CI, 0.31-0.67) and NRS (aOR, 0.45; 95% CI, 0.40-0.49). The association between ICS and NRS differed according to history of asthma ( P = .04 for interaction), with ICS exposure remaining protective only for patients with a history of asthma. Results held true in sensitivity analyses. Interpretation ICS use prior to hospitalization may protect children with DLI from progressing to respiratory failure, with possible differential efficacy according to history of asthma.

Source: CHEST Critical Care

DOI: 10.1016/j.chstcc.2024.100058

Authors: Elizabeth Landzberg, Garrett Keim, Nadir Yehya

Institutions: Children's Hospital of Philadelphia, University of Pennsylvania, Leonard Davis Institute of Health Economics

Language: English

Topic: Respiratory Support and Mechanisms

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500