Work

Severe Exacerbation Trajectories After Inhaled Corticosteroid Initiation in Young Children With Asthma

Year: 2026

Type: article

Abstract: Background: Inhaled corticosteroids (ICSs) are foundational therapy in pediatric asthma; however, evidence guiding initiation and response in preschool-aged children remains limited because of diagnostic uncertainty and inflammatory heterogeneity. Research Question: Among young children with asthma, is initiation of ICSs associated with changes in severe asthma exacerbation trajectories? Study Design and Methods: We conducted a retrospective longitudinal quasi-experimental study using electronic health record data from the Indiana Network for Patient Care (2010-2024). Children who initiated ICSs between 2010 and 2023 and had ≥ 12 months of observation before and after initiation were included (N = 1,396). Annualized severe asthma exacerbations (hospitalization or emergency department visits) were analyzed using piecewise generalized linear mixed-effects models to estimate preinitiation and postinitiation slopes. Recurrent exacerbations were evaluated using Andersen-Gill models, and marginal structural models were applied to address time-varying confounding. Results: Severe asthma exacerbation incidence increased in the year before ICS initiation (13%-38%) and declined during the 1 to 3 years after initiation. In adjusted models, the odds of ≥ 1 severe asthma exacerbation decreased by 34% per year after initiation (adjusted OR, 0.66; 95% CI, 0.59-0.74). ICS initiation was associated with lower recurrent exacerbation hazard in Andersen-Gill models and remained associated with reduced risk in marginal structural models. Greater reductions were observed among children with higher baseline asthma risk, whereas age at initiation did not significantly modify response. Interpretation: Our results show that ICS initiation was associated with significant attenuation of severe exacerbation burden in young children with asthma. These findings support early controller therapy in high-risk preschool populations while underscoring persistent heterogeneity and disparities in asthma outcomes.

Source: CHEST Pulmonary

DOI: 10.1016/j.chpulm.2026.100284

Authors: Arthur H. Owora, Bowen Jiang, Yash Shah

Institutions: Regenstrief Institute, Indiana University School of Medicine

Language: English

Topic: Asthma and respiratory diseases

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