The Impact of Inhaled Corticosteroids on Lung Inflammation and Clinical Outcomes in Children with Oropharyngeal Dysphagia

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics Pub Date : 2025-08-07 DOI:10.1016/j.jpeds.2025.114764

Kelly Quinn MD , Rachel Rosen MD , Rachel D'Anna MB , Suzanne E. Dahlberg PhD , Tregony Simoneau MD

{"title":"The Impact of Inhaled Corticosteroids on Lung Inflammation and Clinical Outcomes in Children with Oropharyngeal Dysphagia","authors":"Kelly Quinn MD , Rachel Rosen MD , Rachel D'Anna MB , Suzanne E. Dahlberg PhD , Tregony Simoneau MD","doi":"10.1016/j.jpeds.2025.114764","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether inhaled corticosteroids (ICS) decrease airway inflammation and hospitalization risk in children with laryngeal penetration or aspiration inferior to the vocal cords.</div></div><div><h3>Study design</h3><div>We performed a retrospective cohort study of 103 children younger than 24 months who had penetration/aspiration determined by initial videofluoroscopic swallowing study (VFSS) between July 2021 and July 2022 and subsequently had a flexible bronchoscopic examination performed at our quaternary care center. Patients were grouped based on exposure to ICS for at least two weeks at the time of bronchoscopy. We compared bronchoalveolar lavage (BAL) neutrophil percentage, qualitative BAL bacterial cultures, and time to first hospitalization after VFSS between groups, using regression analyses. Cox proportional hazards model was performed for analyses of time to hospitalization.</div></div><div><h3>Results</h3><div>Patients prescribed ICS were more likely to have elevated BAL neutrophil percentage (33% vs 15%, OR 2.95; 95% CI 1.08-8.35) and positive bacterial cultures (57% vs 30%, OR 3.41; 95% CI 1.30-9.50), after adjusting for comorbidities. After multivariable analyses, treatment with ICS did not appear to reduce time to hospitalization (hazard ratio 1.06, 95% CI 0.42-2.67), although the number of hospitalizations in both groups was small.</div></div><div><h3>Conclusions</h3><div>In this single-center, retrospective study, ICS was associated with elevated percentage of BAL neutrophils and positive BAL bacterial cultures in children with penetration/aspiration as determined by VFSS. The practice of using of ICS in this population is not supported.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"287 ","pages":"Article 114764"},"PeriodicalIF":3.5000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022347625003051","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To determine whether inhaled corticosteroids (ICS) decrease airway inflammation and hospitalization risk in children with laryngeal penetration or aspiration inferior to the vocal cords.

Study design

We performed a retrospective cohort study of 103 children younger than 24 months who had penetration/aspiration determined by initial videofluoroscopic swallowing study (VFSS) between July 2021 and July 2022 and subsequently had a flexible bronchoscopic examination performed at our quaternary care center. Patients were grouped based on exposure to ICS for at least two weeks at the time of bronchoscopy. We compared bronchoalveolar lavage (BAL) neutrophil percentage, qualitative BAL bacterial cultures, and time to first hospitalization after VFSS between groups, using regression analyses. Cox proportional hazards model was performed for analyses of time to hospitalization.

Results

Patients prescribed ICS were more likely to have elevated BAL neutrophil percentage (33% vs 15%, OR 2.95; 95% CI 1.08-8.35) and positive bacterial cultures (57% vs 30%, OR 3.41; 95% CI 1.30-9.50), after adjusting for comorbidities. After multivariable analyses, treatment with ICS did not appear to reduce time to hospitalization (hazard ratio 1.06, 95% CI 0.42-2.67), although the number of hospitalizations in both groups was small.

Conclusions

In this single-center, retrospective study, ICS was associated with elevated percentage of BAL neutrophils and positive BAL bacterial cultures in children with penetration/aspiration as determined by VFSS. The practice of using of ICS in this population is not supported.

查看原文本刊更多论文

吸入皮质类固醇对口咽吞咽困难患儿肺部炎症及临床结局的影响。

目的：探讨吸入性皮质类固醇（ICS）是否能降低喉部穿透或声带下方吸入性患儿气道炎症和住院风险。我们对103名24个月以下的儿童进行了回顾性队列研究，这些儿童在2021年7月至2022年7月期间通过初始视频透视吞咽研究（VFSS）确定有渗透/吸入，随后在我们的第四护理中心进行了灵活的支气管镜检查。患者根据支气管镜检查时暴露于ICS至少两周进行分组。我们使用回归分析比较各组间支气管肺泡灌洗（BAL）中性粒细胞百分比、定性BAL细菌培养和VFSS后首次住院时间。采用Cox比例风险模型分析住院时间。结果：服用ICS的患者更有可能出现BAL中性粒细胞百分比升高(33% vs 15%, OR 2.95；95% CI 1.08-8.35)和阳性细菌培养(57% vs 30%, OR 3.41；95% CI 1.30-9.50)，校正合并症后。在多变量分析后，吸入皮质类固醇治疗似乎并没有减少住院时间（HR 1.06, 95% CI 0.42-2.67），尽管两组的住院人数都很小。结论：在这项单中心回顾性研究中，通过VFSS检测，ICS与渗透/吸入儿童BAL细菌培养和中性粒细胞百分比升高有关。不支持在这类人群中使用ICS。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Pediatrics 医学-小儿科

CiteScore

6.00

自引率

2.00%

发文量

696

审稿时长

31 days

期刊介绍： The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.