Factors Associated With Inhaled Bronchodilator and Oral Corticosteroid Use in Young Children With First Lower Respiratory Tract Infection

To identify risk factors for use of inhaled bronchodilators (IB) and oral corticosteroids (OCS) in children for their first or index lower respiratory tract infection (LRTI).This study included children less than 2 years old with at least 1 lower respiratory tract infection or wheezing-related visit in the emergency department (ED), inpatient, or outpatient settings between 2015 and 2019. LRTI claims included those for bronchiolitis, pneumonia, and first-time wheezing. Children with a diagnosis of asthma were excluded.This was a retrospective cohort study performed in Colorado. Data were obtained from administrative claims via the Colorado All Payer Claims Database from 2009 to 2019. The primary outcomes were the number of inhaled bronchodilator and oral corticosteroid prescriptions at or within the first 7 days of LRTI. For inpatient visits, the date of discharge was used as day 0. The primary predictor for IB or OCS was prescribing momentum, defined as prior use of these medications. Other covariates included demographics, family history of asthma or atopy, previous inhaled corticosteroid use, and presence of complex chronic conditions.There were 10,194 subjects analyzed. Of subjects, 14.4% had an inhaled bronchodilator claim and 7.3% had an oral corticosteroid claim. There were significantly more inhaled bronchodilator prescriptions in outpatient settings (17%) than inpatient or ED settings (7% and 8%, respectively). In the cohort’s preceding claims, 1.4% had an IB, 5.1% had an OCS, and 0.4% had an inhaled corticosteroid. When adjusting for covariates, prior IB and OCS claims were associated with older age, public insurance, noninpatient location of index LRTI, and IB and OCS use during index LRTIs. Individuals with inhaled bronchodilator claims were more likely to be male and have a history of atopy. There were no differences in outcome associated with insurance type, family history of atopy or asthma, or presence of complex chronic conditions.In patients with index LRTIs, approximately 14% of young children had an inhaled bronchodilator claim and 7% had an oral corticosteroid claim. Factors that were more associated with inhaled bronchodilators and oral corticosteroids included older age, male sex, history of atopy, public insurance, ED or outpatient setting, and previous bronchodilator or oral steroid use.Despite current American Academy of Pediatric recommendations, several patients in this study received either inhaled bronchodilators or oral corticosteroids for their first LRTI. Although infrequent, prior IB and OCS claims predicted claims for future use of these medications. Children < 2 years of age are highly susceptible to recurrent LRTIs, especially in daycare settings. If therapeutic momentum perpetuates in these patients, negative effects of recurrent OCS use may be seen. OCS were often given in the outpatient setting, which highlights the need for continuing education regarding current guidelines.