Source:

Clark
AJ
,
Dong
N
,
Roth
T
, et al
.
Factors associated with asthma diagnosis within five years of a bronchiolitis hospitalization: a retrospective cohort study in a high asthma prevalence population
.
Hosp Pediatr.
2019
;
9
(
10
):
794
800
; doi:
https://doi.org/10.1542/hpeds.2019-0062

Investigators at several institutions conducted a retrospective cohort study to assess the proportion of infants with asthma within 5 years of hospitalization for bronchiolitis and to explore which clinical and demographic factors are associated with a subsequent asthma diagnosis. Infants were eligible if they were <12 months of age and were hospitalized for bronchiolitis between 2007–2009 at a US urban tertiary care hospital that serves a population with a high asthma prevalence. Infants with chronic lung disease, bronchopulmonary dysplasia, or cystic fibrosis were excluded. Demographics, family history of asthma, and clinical characteristics of the index bronchiolitis admission (eg, length of hospitalization, ICU stay, and supplemental oxygen requirement) were obtained from the medical record.

The primary outcome was a diagnosis of asthma within 5 years of an infant’s index hospitalization for bronchiolitis. Asthma diagnosis was defined as (a) hospitalization, ED visit, or outpatient visit for asthma as determined by ICD-9 codes; (b) asthma listed on the patient’s medical record problem list; or (c) a prescription for asthma controller medication. Investigators used multivariable logistic regression models to determine the independent association of an asthma diagnosis with demographics and clinical characteristics of the index bronchiolitis admission.

There were 534 infants included in analysis. Of these, 294 (55%) had a diagnosis of asthma within 5 years of discharge. Females (vs males) had significantly decreased odds of asthma (adjusted odds ratio [aOR], 0.46; 95% CI, 0.26–0.81). Age and race were also significantly associated with an asthma diagnosis in infants without a family history of asthma. There were significantly increased odds of asthma with each month of age at the time of the index bronchiolitis admission (aOR, 1.19; 95% CI, 1.08–1.32) and increased odds among black (vs white) infants (aOR, 4.06; 95% CI, 1.56–10.58). There was no significant association between clinical characteristics of the index bronchiolitis admission and an asthma diagnosis within 5 years.

The investigators conclude that, in the study population, there is a high prevalence of asthma diagnoses within 5 years of bronchiolitis admission, and that demographic factors, not clinical factors, are associated with future asthma diagnosis.

Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Even in an area with a high prevalence of childhood asthma (estimated at 15% at the location of the hospital where the data for the current study were collected), the results of the study suggest that hospitalization for bronchiolitis significantly increases the chances that a child will be diagnosed with asthma. Most of the risk factors identified (male sex, black race, family history of asthma) for the development of asthma in infants hospitalized...

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