Abstract
Rationale: In the outpatient setting, inhaled corticosteroids
(ICS) are frequently given to children with bronchopulmonary dysplasia
(BPD) for treatment of respiratory and asthma associated symptoms. In
this study we sought to determine if correlations existed between ICS
use and ICS initiation and patient characteristics and outpatient
respiratory outcomes. Methods: This study included children
with the diagnosis of BPD (n=661) who were seen in outpatient pulmonary
clinics at the Children’s Hospital of Philadelphia between 2016-2021.
Chart review was used to determine patient demographics, use and timing
of ICS initiation, asthma diagnosis and acute care usage following
initial hospital discharge. Results: At the first pulmonary
visit, 9.2% of children had been prescribed an ICS at NICU discharge,
13.9% had been prescribed an ICS after NICU discharge but before their
first pulmonary appointment, and 6.9% were prescribed an ICS at
completion of initial pulmonary visit. Children started on an ICS as
outpatients, had a higher likelihood of ER visits (adjusted OR: 2.68
±0.7), hospitalizations (4.81 ± 1.16) and a diagnosis of asthma (3.58 ±
0.84), compared to children never on an ICS. Of those diagnosed with
asthma, children prescribed an ICS in the outpatient setting received
the diagnosis at an earlier age. No associations between NICU BPD
severity scores and ICS use were found. Conclusions: This study
identifies an outpatient BPD phenotype associated with ICS use and ICS
initiation independent of NICU severity score. Additionally, outpatient
ICS initiation correlates with a subsequent diagnosis of asthma and
acute care usage in children with BPD.