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Inhaled Corticosteroids Use Before Hospitalization May Be Protective in Children With Direct Lung Injury

Elizabeth Landzberg1, Garrett Keim2, Nadir Yehya2

  • 1Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA.

CHEST Critical Care
|September 20, 2024
PubMed

Insights

Inhaled corticosteroids (ICSs) may reduce respiratory failure in children with direct lung injury (DLI). This protective effect was more pronounced in children with a history of asthma.

Area of Science:

  • Pediatric Pulmonology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Systemic corticosteroids have uncertain benefits in acute respiratory failure due to side effects.
  • Inhaled corticosteroids (ICSs) offer localized anti-inflammatory effects.
  • The protective role of ICSs in children with direct lung injury (DLI) is not well-established.

Purpose of the Study:

  • To investigate whether children with DLI prescribed ICSs before hospitalization have reduced odds of progressing to respiratory failure.
  • To assess the association between pre-hospitalization ICS use and the need for intubation or noninvasive respiratory support (NRS) in children with DLI.

Main Methods:

  • Retrospective, single-center cohort study of children presenting to the ED with DLI.
  • Medication records were reviewed for ICS use prior to hospitalization.
  • Outcomes included intubation (primary) and NRS (secondary), with adjustments for confounders and a sensitivity analysis for systemic corticosteroid use.

Main Results:

  • ICS use was associated with significantly lower odds of intubation (aOR, 0.46) and NRS (aOR, 0.45).
  • The protective association of ICSs with NRS differed based on a history of asthma (P = .04 for interaction).
  • ICSs demonstrated a protective effect primarily in children with a history of asthma.

Conclusions:

  • Pre-hospitalization ICS use may protect children with DLI from respiratory failure.
  • The efficacy of ICSs may be differential, potentially being more effective in children with a history of asthma.
Abstract

Keywords:
ARDSdirect lung injuryinhaled corticosteroidsintubationnoninvasive respiratory supportnoninvasive ventilationpediatricrespiratory failure

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