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Published on: August 7, 2017
Risk of pneumonia in asthmatic children using inhaled corticosteroids: a nested case-control study in a birth cohort
Pragya Shrestha1,2, Chung-Il Wi1,2, Hongfang Liu3
1Precision Population Science Lab, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Inhaled corticosteroids (ICSs) did not increase pneumonia risk in children with asthma. Poorly controlled asthma, however, was linked to a higher risk of pneumonia in this pediatric population.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Epidemiology
Background:
- Inhaled corticosteroids (ICSs) are a cornerstone of asthma management.
- Concerns exist regarding a potential increased risk of pneumonia with ICS use.
- The association between ICSs and pneumonia risk in pediatric asthma populations remains unclear.
Purpose of the Study:
- To investigate the association between inhaled corticosteroid (ICS) use and the risk of pneumonia in children diagnosed with asthma.
- To examine if ICS type or dosage influences pneumonia risk in pediatric asthma patients.
Main Methods:
- A nested case-control study utilized data from the Mayo Clinic Birth Cohort (1997-2016).
- Asthmatic children (<18 years) were identified, and pneumonia cases were matched 1:1 with controls.
- Conditional logistic regression analyzed the association of ICS exposure (prescription >90 days prior) with pneumonia risk, considering ICS type and dose.
Main Results:
- Inhaled corticosteroid (ICS) use was not significantly associated with an increased risk of pneumonia in asthmatic children (adjusted OR: 0.94).
- Poorly controlled asthma emerged as a significant risk factor for pneumonia (OR: 2.03, p<0.001).
- No specific ICS type or dose demonstrated a statistically significant association with pneumonia risk.
Conclusions:
- Inhaled corticosteroid (ICS) therapy does not appear to elevate pneumonia risk in children with asthma.
- Poor asthma control is a significant predictor of pneumonia in pediatric asthma patients.
- Future research on asthma management should consider pneumonia as a relevant clinical outcome.
Background:
Inhaled corticosteroids (ICSs) are important in asthma management, but there are concerns regarding associated risk of pneumonia. While studies in asthmatic adults have shown inconsistent results, this risk in asthmatic children is unclear.
Objective:
Our aim was to determine the association of ICS use with pneumonia risk in asthmatic children.
Methods:
A nested case-control study was performed in the Mayo Clinic Birth Cohort. Asthmatic children (<18 years) with a physician diagnosis of asthma were identified from electronic medical records of children born at Mayo Clinic from 1997 to 2016 and followed until 31 December 2017. Pneumonia cases defined by Infectious Disease Society of America were 1:1 matched with controls without pneumonia by age, sex and asthma index date. Exposure was defined as ICS prescription at least 90 days prior to pneumonia. Associations of ICS use, type and dose (low, medium and high) with pneumonia risk were analysed using conditional logistic regression.
Results:
Of the 2108 asthmatic children eligible for the study (70% mild intermittent and 30% persistent asthma), 312 children developed pneumonia during the study period. ICS use overall was not associated with risk of pneumonia (adjusted OR: 0.94, 95% CI: 0.62 to 1.41). Poorly controlled asthma was significantly associated with the risk of pneumonia (OR: 2.03, 95% CI: 1.35 to 3.05; p<0.001). No ICS type or dose was associated with risk of pneumonia.
Conclusion:
ICS use in asthmatic children was not associated with risk of pneumonia but poorly controlled asthma was. Future asthma studies may need to include pneumonia as a potential outcome of asthma management.
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