Outpatient Inhaled Corticosteroid Use in Bronchopulmonary Dysplasia

Rationale: In the outpatient setting, inhaled corticosteroids (ICS) are frequently given to children with bronchopulmonary dysplasia (BPD) for treatment of respiratory and asthma associated symptoms. In this study we sought to determine if correlations existed between ICS use and ICS initiation and patient characteristics and outpatient respiratory outcomes. Methods: This study included children with the diagnosis of BPD (n=661) who were seen in outpatient pulmonary clinics at the Children’s Hospital of Philadelphia between 2016-2021. Chart review was used to determine patient demographics, use and timing of ICS initiation, asthma diagnosis and acute care usage following initial hospital discharge. Results: At the first pulmonary visit, 9.2% of children had been prescribed an ICS at NICU discharge, 13.9% had been prescribed an ICS after NICU discharge but before their first pulmonary appointment, and 6.9% were prescribed an ICS at completion of initial pulmonary visit. Children started on an ICS as outpatients, had a higher likelihood of ER visits (adjusted OR: 2.68 ±0.7), hospitalizations (4.81 ± 1.16) and a diagnosis of asthma (3.58 ± 0.84), compared to children never on an ICS. Of those diagnosed with asthma, children prescribed an ICS in the outpatient setting received the diagnosis at an earlier age. No associations between NICU BPD severity scores and ICS use were found. Conclusions: This study identifies an outpatient BPD phenotype associated with ICS use and ICS initiation independent of NICU severity score. Additionally, outpatient ICS initiation correlates with a subsequent diagnosis of asthma and acute care usage in children with BPD.