Adverse drug events due to anti-asthmatic medications have been substantially rising during the past two decades among younger children.

Studies have shown that asthma medication adherence is below 50% in children, and one of the top reasons for non-adherence is the fear of adverse drug events (ADEs), explains Luyu (Amber) Xie, PharmD. “To date, there have been no efforts to assess temporal trends in inpatient ADEs related to asthma medications by major drug classes in the United States. Therefore, a need exists to describe the incidence of asthma ADEs using real-world evidence to inform the public and key stakeholders.”

For a study published in Drugs-Real World Outcomes, Dr. Xie, Sarah E. Messiah, MPH, PhD, and colleagues examined incidence trends, healthcare utilization, and risk factors of ADEs related to anti-asthmatic medications by major drug classes in hospitalized children with asthma. A population-based temporal analysis was conducted using the Kids Inpatients Database, which included patients aged 0-20 hospitalized with asthma (N=698,501) from 2000-2016.

ADEs Incidences Due to Anti-Asthmatic Medications Rose Nearly Five Times

The study team estimated age-stratified, weighted, temporal trends of the incidence of ADEs related to anti-asthmatic medications, such as corticosteroids and bronchodilators. Risk factors for adverse drug events were generated by stepwise multivariate logistic regression models.

Three key findings were observed. “First, during the study period, pediatric inpatient data show that the incidence of ADEs related to anti-asthmatic medications has increased nearly five times, especially among pre-school-aged children using bronchodilators,” says Dr. Xie. “Second, ADEs related to anti-asthmatic medication are linked with extended hospital stay and additional healthcare charges. Finally, very young children with complex medical situations may gain the most from monitoring for ADEs.”

ADEs Due to Corticosteroids Linked With Increase in Hospital Length of Stay

A major takeaway from the study is that ADEs due to corticosteroids were correlated with an increase in hospital length of stay and hospitalization charges. “What’s interesting is that ADEs from bronchodilators were associated with a reduced length of hospital stay but a slight increase in hospitalization charges,” Dr. Messiah notes. “Although there are no clear explanations, we hypothesize that it could be due to the possible increased use of higher doses of albuterol. Additionally, ADEs from both classes were not linked with inpatient mortality (Table).

Pre-school-aged children with complex health conditions who use bronchodilators were found to be at the highest risk for adverse drug events. Drs. Xie, Messiah, and colleagues suggest involving pharmacists in medication reviews for this population to help avoid preventable ADEs.

Studies Examining ADEs in Non-Hospital Setting Needed

The study team acknowledges a limitation of this study in that it only examined the incidence of ADEs in in hospitalized patients. “In the future, we would like to see research that explores ADEs in patients in a non-hospital setting,” Dr. Messiah says. “Studies examining ADEs from individual asthma medications and the influence of changes in dose and duration are also needed.”

This study concurs with previous research that indicates that ADEs due to anti-asthmatic medications have been substantially rising during the past two decades among younger children, contributing to increased healthcare costs. “Our findings can inform healthcare systems that greater efforts are needed to prevent ADEs due to anti-asthmatic medications,” Dr. Xie says.