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

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.