Addressing ICS Hesitancy in Pediatric Asthma Care, With Lynchi Nguyen

Inhaled corticosteroids (ICS) did not increase fracture risk in children with asthma according to new data from a retrospective cohort analysis presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting held in Philadelphia, Pennsylvania on February 27-March 2.

The study included more than 210,000 pediatric asthma patients in the TriNetX United States Collaborative Network. Investigator Lynchi Nguyen, medical student at John Sealy School of Medicine, University of Texas Medical Branch in Galveston, sat down with HCPLive during the meeting to discuss the findings.

Nguyen emphasized that children treated with short-acting beta agonist (SABA) monotherapy had an 18% higher fracture risk compared with those receiving ICS-only regimens (RR, 1.18; 95% CI, 1.11–1.26). No significant differences in fracture risk were observed between ICS + LABA therapy and SABA-only treatment (RR, 1.05; 95% CI, 0.95–1.15), or between ICS + LABA and ICS-only regimens (RR, 0.97; 95% CI, 0.86–1.09).

The findings, which focused specifically on pediatric-relevant fractures, including Salter-Harris, torus, greenstick, and bent bone fractures occurring at least one year after medication initiation, directly address a longstanding patient concern in pediatric asthma management. While systemic corticosteroids are known to adversely affect bone density in growing children, inhaled corticosteroids have often been viewed with similar suspicion by families and even some clinicians.

Nguyen explained that this misconception may contribute to persistent reliance on SABA monotherapy, despite international guidelines that recommend early incorporation of ICS-containing regimens and movement toward SMART therapy strategies. The new data reinforce that ICS use does not confer the skeletal risks associated with systemic steroids and may even be protective, potentially by reducing exacerbations and limiting systemic steroid bursts.

Beyond reassuring families, the study also offers clinicians flexibility in treatment selection. Because no fracture risk differences were seen between ICS-only and ICS + LABA regimens, providers can tailor therapy based on access, cost, insurance coverage, and disease severity without concern for differential skeletal effects.

Looking ahead, Nguyen suggested that future research should shift toward examining prescribing trends and adherence patterns to determine whether safety data such as these are translating into greater guideline adherence. The larger goal is clear: improving asthma outcomes by confidently incorporating ICS early and consistently in pediatric care.

“If patients are getting diagnosed at a young age, there shouldn't be any hesitancy to start [ICS, or] worrying if this will affect their growth, worrying about their bone density or bone health. I think our study can help clarify that there is no proven increased risk of, you know, detrimental effects to bone health,” Nguyen said.

Nguyen had no relevant disclosures to report.

Reference
Nguyen L, Lee A, Carmichael K, Acevado JA. Fracture Risk Among Pediatric Asthma Patients Treated With Inhaled Corticosteroids: A Retrospective Cohort Study. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Poster #L04