Pediatric Hospital Medicine Fellow University of Colorado Denver/Children's Hospital Colorado University of Colorado Denver Denver, Colorado, United States
Background: While asthma controllers (inhaled corticosteroids and leukotriene inhibitors) have been shown to reduce exacerbations in children 2-5 years old with asthma or recurrent wheeze, deciding when to prescribe controllers in children <2 years old remains challenging given the substantial clinical overlap between asthma and lower respiratory tract infections (LRTIs).
Objective: To assess the association between prescribed controller medications and emergency department (ED) and inpatient (IP) visits for LRTI or asthma in children <2 years old.
Design/Methods: Retrospective cohort study using administrative claims data. Children <2 years old with at least one prior LRTI (bronchiolitis and pneumonia) were identified in the 2009-2017 Colorado All Payer Claims Database. Those with complex chronic conditions, a diagnosis of asthma prior to first LRTI, or controller use prior to first LRTI were excluded. The primary exposure variable was time on controller (prescription for controller) calculated in person-time. The primary outcome was count of ED/IP visits for any diagnosis of LRTI or ED/IP visit for a primary diagnosis of asthma after the first LRTI (using ICD9/10 codes). A Poisson regression model assuming correlated intervals within subjects was used. Adjusted models included baseline covariates of gender, insurance type, prematurity, family history of asthma, and time-dependent covariates of prior wheeze, atopy, number of LRTI visits, LRTI hospitalizations, and beta agonist prescriptions.
Results: We identified 40,473 children meeting inclusion criteria, ultimately constituting 547,082 person-months. The overall cohort characteristics are described in Table 1. A larger percentage of person-time on controller compared to off controller was seen with older age, male gender, Medicaid insurance, family history of asthma, prior atopy, prior wheeze, more prior LRTI visits, and prior beta agonist prescription (Table 2). Controller medication use was not significantly associated with a reduction in ED/IP visits for LRTI or asthma in the adjusted model (RR 0.77; 95% CI: 0.57, 1.05) (Table 3). Conclusion(s): In children under 2 with LRTI, controllers are more often prescribed in those who have more risk factors for future asthma. However, we found that time on controllers did not statistically reduce ED/IP visits for related respiratory diagnoses in this age group.
Authors/Institutions: John D. Watson, University of Colorado Denver, Denver, Colorado, United States; Angela Moss, University of Colorado, Aurora, Colorado, United States; John D. Rice, University of Colorado, Denver - Anschutz Medical Campus, Aurora, Colorado, United States; Lilliam Ambroggio, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States; Amy Tyler, University of Colorado, Aurora, Colorado, United States; Mark Brittan, Children's Hospital Colorado, Aurora, Colorado, United States
