Factors Associated with Inhaled Bronchodilator and Oral Corticosteroid Use in Young Children with First Lower Respiratory Tract Infection

J Pediatr. 2024 Apr:267:113912. doi: 10.1016/j.jpeds.2024.113912. Epub 2024 Jan 19.


Objectives: To examine factors associated with claims for and potential overuse of inhaled bronchodilators (IBs) and oral corticosteroids (OCSs) for children <2 years old at first lower respiratory tract infections (LRTIs).

Study design: Retrospective cohort study using Colorado All Payer Claims data from 2009 through 2019. Children with asthma were excluded. Primary outcomes were 1) IB and 2) OCS claims within 7 days of index LRTI. Primary predictors were previous IB or OCS claims for each outcome respectively. Covariates included demographics, atopy, family history of asthma, complex chronic conditions, prior inhaled corticosteroid claim, and location of index LRTI. Separate multivariable logistic regression models were used for each outcome.

Results: Of 10 194 eligible children, 1468 (14.4%) had an IB and 741 (7.3%) an OCS claim at or within 7 days of index LRTI. Index LRTIs were most often at outpatient visits (64%). Adjusting for covariates, prior IB prescription was associated with the IB outcome (aOR 1.9; 95% CI 1.3, 2.8), and prior OCS prescription was associated with the OCS outcome (AOR 2.2; 95% CI 1.7, 2.9). Other variables associated with either outcome included age, sex, insurance, location, and atopy. Prior inhaled corticosteroid claim, asthma family history, and complex chronic conditions were not associated with either outcome.

Conclusions: This study identifies factors that might serve as opportunities for de-implementation strategies for IB and OCS overuse in young children with LRTI.

Keywords: bronchiolitis; bronchodilators; corticosteroids; pediatric; pneumonia.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Asthma* / drug therapy
  • Bronchodilator Agents / therapeutic use
  • Child
  • Child, Preschool
  • Chronic Disease
  • Humans
  • Respiratory Tract Infections* / drug therapy
  • Retrospective Studies


  • Bronchodilator Agents
  • Adrenal Cortex Hormones