Intraoperative Bronchospasm and Future Asthma in Children: A Retrospective Matched Cohort Study

Asthma is the most common chronic disease in children. Difficulty in diagnosis can lead to decreased quality of life and increased morbidity and mortality. Children with asthma have increased intraoperative bronchospasm; however, it is unclear whether intraoperative bronchospasm predicts future asthma. We explored intraoperative bronchospasm and subsequent asthma diagnosis.

We retrospectively analyzed 44,284 children aged 2-18 years who underwent non-cardiac surgery under general anesthesia between 2014 and 2020. We collected demographic and peri-operative data, including the occurrence of bronchospasm. We then conducted a subgroup analysis of 35 770 patients that received positive pressure ventilation, using logistic regression to assess the relationship between bronchospasm and airway pressures. The association of bronchospasm and subsequent asthma diagnosis was estimated using generalized estimating equations.

Intraoperative bronchospasm occurred in 128 patients (0.3%) and was associated with increased risk of asthma (OR 2.29, 95% CI 1.10-4.74, p = 0.03). Asthma was diagnosed in 1238 patients (2.8%); 8 had intraoperative bronchospasm (8 of 1238, 0.7%). After adjustment for confounders, male sex (OR 1.57, 95% CI 1.39-1.76, p < 0.001) and younger age (OR 0.96, 95% CI 0.94-0.97, p < 0.001) were also associated with future asthma diagnosis. In the subgroup analysis, Mean PIP (OR 1.50, 95% CI 1.30-1.74, p < 0.001) was associated with asthma.

This study shows intraoperative bronchospasm is associated with an increased risk of future asthma in children. Enhanced collaboration between pediatric anesthesiologists and pediatricians, and further research, is essential to improve asthma detection, risk stratification, and overall care for pediatric patients.