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Recurrent Wheezing in Infants: A Population-Based Study
Manon Belhassen1, Jacques De Blic, Laurent Laforest
1From the Merck Sharp & Dohme, Paris (MB, VL, CC-V, LL); HESPER Claude Bernard University, Lyon (MB, LL, MG, EVG); Pediatric Pulmonology, AP-HP, Necker Enfants Malades Hospital, Paris; Paris Descartes University, Paris, France (JDB); Pediatric Medicine, Caen University Hospital, Caen (JB); Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, Paris (BF); Paris Descartes University, Paris (BF); ESSEC Business School, Paris (GDP); and Respiratory Medicine, Croix Rousse University Hospital, Lyon, France (EVG).
Insights
Recurrent wheezing (RW) is common in infants, affecting 8.2%. Many infants experience inadequate control and high medical resource utilization, highlighting a need for better treatment strategies.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Health Services Research
Background:
- Recurrent wheezing (RW) significantly impacts infants, caregivers, and healthcare systems.
- Limited population-based data exists on the morbidity and medical resource utilization (MRU) associated with infant RW.
- Understanding the burden of RW is crucial for developing targeted interventions.
Purpose of the Study:
- To assess the characteristics, medical management, and MRU of infants with RW using national claims data.
- To identify subgroups of infants with more severe RW and analyze their specific healthcare needs.
- To provide population-based evidence on the real-world impact of infant RW.
Main Methods:
- A nationwide, real-life study identified infants aged 6-24 months with RW based on respiratory drug dispensations and control markers.
- Medical resource utilization was analyzed over 6 months post-index date.
- Subgroups with severe RW were defined by increased respiratory drug use, oral corticosteroid (OCS) use, or hospitalization for respiratory symptoms.
Main Results:
- RW affected 8.2% of infants (115,489 total).
- Inadequate control was prevalent: 61.7% received OCS, 80.2% received antibiotics, and 68.7% received inhaled corticosteroids with low dispensed units, suggesting discontinuous use.
- Severe RW occurred in 39.0% of the cohort, with 5.5% hospitalized for respiratory symptoms.
Conclusions:
- Recurrent wheezing is a common condition in infants, characterized by poor disease control and high medical resource utilization.
- Current treatment strategies appear insufficient, with discontinuous controller therapy use and frequent reliance on rescue medications and antibiotics.
- There is a critical need for interventions to promote adequate controller therapy use and improve overall medical care for infants with RW.
Abstract:
Recurrent wheezing (RW) has a significant impact on infants, caregivers, and society, but morbidity and related medical resource utilization (MRU) have not been thoroughly explored. The burden of RW needs to be documented with population-based data. The objective was to assess the characteristics, medical management, and MRU of RW infants identified from national claims data. Infants aged from 6 to 24 months, receiving ≥2 dispensations of respiratory drugs within 3 months, and presenting a marker of poor control (index date), were selected. During the 6 months after index date, MRU was described in the cohort and among 3 subgroups with more severe RW, defined as ≥4 dispensations of respiratory drugs, ≥3 dispensations of oral corticosteroids (OCS), or ≥1 hospitalization for respiratory symptoms. A total of 115,489 infants had RW, corresponding to 8.2% of subjects in this age group. During follow-up, 68.7% of infants received inhaled corticosteroids, but only 1.8 U (unit) were dispensed over 6 months, suggesting discontinuous use. Control was mostly inadequate: 61.7% of subjects received OCS, 80.2% antibiotics, and 71.2% short-acting beta-agonists, and medical/paramedical visits were numerous, particularly for physiotherapy. Severe RW concerned 39.0% of the cohort; 32.8% and 11.7% of infants had repeated use of respiratory drugs and OCS, respectively, and 5.5% were hospitalized for respiratory symptoms. In this real-life nation-wide study, RW was common and infants had poor control and high MRU. Interventions are needed to support adequate use of controller therapy, and to improve medical care.
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