Severe Exacerbation Trajectories After Inhaled Corticosteroid Initiation in Young Children With Asthma: A Longitudinal Quasi-Experimental Study.
- 1Division of Pediatric Pulmonology, Allergy/Immunology and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
- 2Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN.
Abstract
Inhaled corticosteroids (ICSs) are foundational therapy in pediatric asthma; however, evidence guiding initiation and response in preschool-aged children remains limited because of diagnostic uncertainty and inflammatory heterogeneity. Among young children with asthma, is initiation of ICSs associated with changes in severe asthma exacerbation trajectories? We conducted a retrospective longitudinal quasi-experimental study using electronic health record data from the Indiana Network for Patient Care (2010-2024). Children who initiated ICSs between 2010 and 2023 and had ≥ 12 months of observation before and after initiation were included (N = 1,396). Annualized severe asthma exacerbations (hospitalization or emergency department visits) were analyzed using piecewise generalized linear mixed-effects models to estimate preinitiation and postinitiation slopes. Recurrent exacerbations were evaluated using Andersen-Gill models, and marginal structural models were applied to address time-varying confounding. Severe asthma exacerbation incidence increased in the year before ICS initiation (13%-38%) and declined during the 1 to 3 years after initiation. In adjusted models, the odds of ≥ 1 severe asthma exacerbation decreased by 34% per year after initiation (adjusted OR, 0.66; 95% CI, 0.59-0.74). ICS initiation was associated with lower recurrent exacerbation hazard in Andersen-Gill models and remained associated with reduced risk in marginal structural models. Greater reductions were observed among children with higher baseline asthma risk, whereas age at initiation did not significantly modify response. Our results show that ICS initiation was associated with significant attenuation of severe exacerbation burden in young children with asthma. These findings support early controller therapy in high-risk preschool populations while underscoring persistent heterogeneity and disparities in asthma outcomes.
Related
- Association between platelet-to-white blood cell ratio trajectories and all-cause mortality in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study.
- Early-Age alcohol initiation increases the risk of mental disorders in children and adolescents: a longitudinal cohort study
- Persistent Post-Burn Pruritus Following Antihistamine Initiation: A Retrospective Longitudinal Study at a Single Italian Pediatric Burn Center
- Early Relative eGFR Decline After SGLT2 Inhibitor Initiation in Heart Failure: Clinical Correlates and Pretreatment-Anchored 12-Month Trajectories
- Socioeconomic position and functional dependency trajectories across six longitudinal ageing cohorts
BibTeX
@article{owora2026severe,
title = {{Severe Exacerbation Trajectories After Inhaled Corticosteroid Initiation in Young Children With Asthma: A Longitudinal Quasi-Experimental Study.}},
author = {Arthur H Owora and Bowen Jiang and Yash Shah},
journal = {CHEST pulmonary},
year = {2026},
month = jul,
doi = {10.1016/j.chpulm.2026.100284},
url = {https://europepmc.org/article/MED/42999848},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Severe Exacerbation Trajectories After Inhaled Corticosteroid Initiation in Young Children With Asthma: A Longitudinal Quasi-Experimental Study.
AU - Arthur H Owora
AU - Bowen Jiang
AU - Yash Shah
PY - 2026
DA - 2026/07/14
JO - CHEST pulmonary
DO - 10.1016/j.chpulm.2026.100284
UR - https://europepmc.org/article/MED/42999848
AB - Inhaled corticosteroids (ICSs) are foundational therapy in pediatric asthma; however, evidence guiding initiation and response in preschool-aged children remains limited because of diagnostic uncertainty and inflammatory heterogeneity. Among young children with asthma, is initiation of ICSs associated with changes in severe asthma exacerbation trajectories? We conducted a retrospective longitudinal quasi-experimental study using electronic health record data from the Indiana Network for Patient Care (2010-2024). Children who initiated ICSs between 2010 and 2023 and had ≥ 12 months of observation before and after initiation were included (N = 1,396). Annualized severe asthma exacerbations (hospitalization or emergency department visits) were analyzed using piecewise generalized linear mixed-effects models to estimate preinitiation and postinitiation slopes. Recurrent exacerbations were evaluated using Andersen-Gill models, and marginal structural models were applied to address time-varying confounding. Severe asthma exacerbation incidence increased in the year before ICS initiation (13%-38%) and declined during the 1 to 3 years after initiation. In adjusted models, the odds of ≥ 1 severe asthma exacerbation decreased by 34% per year after initiation (adjusted OR, 0.66; 95% CI, 0.59-0.74). ICS initiation was associated with lower recurrent exacerbation hazard in Andersen-Gill models and remained associated with reduced risk in marginal structural models. Greater reductions were observed among children with higher baseline asthma risk, whereas age at initiation did not significantly modify response. Our results show that ICS initiation was associated with significant attenuation of severe exacerbation burden in young children with asthma. These findings support early controller therapy in high-risk preschool populations while underscoring persistent heterogeneity and disparities in asthma outcomes.
SN - 2949-7892
ER -