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Association of corticosteroid use and attention deficit/hyperactivity disorder in asthmatic children varies by age
Luyu Xie1,2, Andrew Gelfand3, M Sunil Mathew1,2
1School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA.
Insights
Inhaled corticosteroids are linked to higher ADHD odds in younger children with asthma. No significant association was found in older children or with oral corticosteroid use alone.
Area of Science:
- Pediatric pulmonology
- Child psychiatry
- Pharmacovigilance
Background:
- Asthma is a common chronic respiratory disease in children.
- Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder.
- Corticosteroids are frequently used to manage asthma, with varying administration routes.
Purpose of the Study:
- To investigate the association between corticosteroid use and ADHD in pediatric asthma patients.
- To explore how administration routes (inhaled vs. oral) and asthma severity influence this association.
- To examine age-related differences in the impact of corticosteroids on ADHD.
Main Methods:
- A population-based, cross-sectional analysis using the Kids Inpatient Database (2016, 2019).
- Included pediatric patients aged 5-20 years with asthma.
- ICD-10-CM codes identified corticosteroids use, asthma, and ADHD; logistic regression and IPW controlled for confounding.
Main Results:
- In children aged 5-11, inhaled corticosteroids were associated with higher ADHD odds in moderate-to-severe asthma (aOR 1.46-1.61).
- Combined inhaled and oral corticosteroid use showed significantly higher ADHD odds in severe asthma (aOR 4.85).
- No significant association between corticosteroid use and ADHD was observed in asthmatic children aged 12-20 years.
Conclusions:
- Inhaled corticosteroids are positively associated with ADHD in younger children (5-11 years) with moderate to severe asthma.
- This association was not observed in older children (12-20 years) with asthma.
- Findings highlight potential age-specific effects of inhaled corticosteroids on neurodevelopment in pediatric asthma.
Objective:
We aim to examine the impact of corticosteroids use on ADHD among children with asthma by administration routes.
Methods:
A population-based, cross-sectional analysis included pediatric patients ages 5-20 years old from the 2016 and 2019 Kids Inpatient Database (unweighted N = 111,702). ICD-10-CM codes were used to identify corticosteroids use, asthma, and ADHD cases. Survey logistic regression models with purposeful variable selection algorithms were built to examine the association between corticosteroids use, and ADHD by asthma severity and age. An inverse probability weighting (IPW) approach was used to help further control residual confounding.
Results:
Among children aged 5-11 years old, the odds of ADHD were significantly higher in children with moderate to severe asthma who used inhaled corticosteroids than nonusers (moderate asthma: adjusted odds ratios [aOR] 1.46, 95% confidence interval [CI] 1.14-2.44; severe asthma: aOR 1.61, 95% CI 1.18-2.21). Although oral corticosteroid use was not independently associated with ADHD in young children, combined use of inhaled and oral corticosteroid had almost 5 times higher odds of use among ADHD in children with severe asthma vs. nonusers (aOR 4.85, 95% CI 2.07 - 11.35). No associations were found between any corticosteroid use and ADHD among asthmatic children aged 12-20 years.
Conclusions:
In this retrospective analysis, we found inhaled corticosteroids were positively associated with ADHD in younger children with moderate to severe asthma, but not in older children.
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