Estimation of short-course systemic corticosteroid risks on adverse outcomes in childhood asthma

Short-course systemic corticosteroids (SCS) are recommended for moderate-to-severe pediatric asthma exacerbations, though frequent courses may cause adverse outcomes. We examined the risk of adverse outcomes in asthmatic children who received multiple SCS courses for exacerbation management. We conducted a retrospective study of children aged 1–16 years with an asthma emergency department presentation/hospitalization between October 1, 2017, and February 28, 2021. Using a Prentice-Williams-Peterson total time model, we compared steroid-associated adverse outcomes among children who received or did not receive short courses of SCS for asthma exacerbations over ≥ 24-months. Among 2009 eligible children, 1468 received ≥ 1 SCS course for asthma exacerbations and 541 did not receive SCS. Overall, there was no increase in the risk of recurrent SCS-associated adverse outcomes in those exposed to SCS (aHR = 0.95, 95% CI 0.74–1.23, p = 0.7), however, the number of SCS courses received significantly affected the risk of recurrent adverse outcomes (p = 0.029). Children receiving 2 SCS courses had a reduced risk of adverse outcomes (aHR = 0.49, 95% CI: 0.28–0.88), while those receiving ≥ 4 SCS courses experienced a non-significant, yet clinically meaningful elevated risk of adverse outcomes (aHR = 2.30, 95% CI 0.92–5.80). This study shows that SCS administered for pediatric asthma exacerbations are generally safe; however, complication risk may be increased when receiving 4 + SCS courses and synergistic with higher-dose inhaled corticosteroids.