Emergency management and asthma risk in young Medicaid-enrolled children with recurrent wheeze

Abstract

Objectives

To describe clinical characteristics of young children presenting to the emergency department (ED) for early recurrent wheeze, and determine factors associated with subsequent persistent wheeze and risk for early childhood asthma.

Methods

Retrospective cohort study of Medicaid-enrolled children 0–3 years old with an index ED visit for wheeze (e.g. bronchiolitis, reactive airway disease) from 2009 to 2013, and at least one prior documented episode of wheeze at an ED or primary care visit. The primary outcome was persistent wheeze between 4 and 6 years of age. Demographics and clinical characteristics were collected from the index ED visit. Logistic regression was used to estimate the association between potential risk factors and subsequent persistent wheeze.

Results

During the study period, 41,710 children presented to the ED for recurrent wheeze. Mean age was 1.3 years; 59% were male, 42% Black, and 6% Hispanic. At index ED visits, the most common diagnosis was acute bronchiolitis (40%); 77% of children received an oral corticosteroid prescription. Between 4 and 6 years of age, 11,708 (28%) children had persistent wheeze. A greater number of wheezing episodes was associated with an increased odds of ED treatment with asthma medications. Subsequent persistent wheeze was associated with male sex, Black race, atopy, prescription for bronchodilators or corticosteroids, and greater number of visits for wheeze.

Conclusions

Young children with persistent wheeze are at risk for childhood asthma. Thus, identification of risk factors associated with persistent wheeze in young children with recurrent wheeze might aid in early detection of asthma and initiation of preventative therapies.

Keywords:

• Bronchiolitis
• asthma
• wheeze
• children
• bronchodilators
• corticosteroids
• treatment

Authors’ Contributions

Dr. Isabel Hardee was responsible for conceptualization and design of this study, drafted the manuscript, and was responsible for data curation and funding acquisition. Dr. Isabella Zaniletti was responsible for conceptualization and design of this study, methodology, data curation, formal analysis, and review of the manuscript. Dr. Melisa Tanverdi was responsible for conceptualization and design of this study, methodology, investigation, and review of the manuscript. Dr. Andrew Liu was responsible for investigation, supervision and oversight, and review of the manuscript. Dr. Rakesh Mistry was responsible for conceptualization and design of this study, methodology, investigation, supervision and oversight, and review of the manuscript. Dr. Nidhya Navanandan was responsible for conceptualization and design of this study, methodology, investigation, supervision and oversight, funding acquisition, and review of the manuscript.

Disclosure statement

The authors have no conflicts of interest to disclose.

Additional information

Funding

This study was supported by the National Institutes of Health/National Heart, Lung and Blood Institute (K23HL161354 to NN, R38HL143511 to IH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations. The funding organizations had no role in the design, preparation, review, or approval of this paper.