{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T02:29:22Z","timestamp":1771554562818,"version":"3.50.1"},"reference-count":21,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Differentiating bronchiolitis from other lower respiratory tract (LRT) diagnoses is challenging because of shared clinical features. We hypothesized that recently reported decreases in nonrecommended bronchiolitis therapies may be overestimated because of shifts in diagnostic assignment.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We performed a multicenter retrospective cohort study across 40 hospitals from 2010 to 2022 using the Pediatric Health Information Systems database. For children aged younger than 2\u00a0years with LRT discharge diagnoses, we analyzed trends in (1) the proportion of encounters with assigned diagnosis of bronchiolitis, asthma (including \u201creactive airway disease\u201d), and pneumonia and (2) the receipt of bronchodilators, systemic steroids, and\/or antibiotics.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n We identified 1\u2009023\u2009745 encounters with an LRT diagnosis. The proportion of LRT conditions diagnosed as bronchiolitis increased from 55.4% to 79.6% (adjusted incidence rate ratio [aIRR], 1.022; 95% CI, 1.019\u20131.026), signifying a relative increase of 2.2% per year, while asthma decreased from 22.1% to 6.1% (aIRR, 0.918; 95% CI, 0.897\u20130.939), and pneumonia decreased from 12.5% to 4.7% (aIRR, 0.925; 95% CI, 0.913\u20130.937). Across all LRT diagnoses, bronchodilator and steroid use decreased from 49.5% to 28.6% (aIRR, 0.947; 95% CI, 0.936\u20130.958) and 23.3% to 18.4% (aIRR, 0.982; 95% CI, 0.972\u20130.992), respectively. Similarly, antibiotic use declined from 13.9% to 10% (aIRR, 0.975; 95% CI, 0.962\u20130.989). Revisits with LRT diagnoses were unchanged.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The proportion of LRT conditions identified as bronchiolitis has increased over time, while nonrecommended bronchiolitis therapies have decreased. Further exploration is needed to elucidate this relationship, which suggests a potential influence of therapeutic stewardship on ultimate diagnoses.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2025-071946","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:02:21Z","timestamp":1761696141000},"source":"Crossref","is-referenced-by-count":1,"title":["Trends in Lower Respiratory Tract Diagnoses and Nonrecommended Bronchiolitis Therapies"],"prefix":"10.1542","volume":"156","author":[{"given":"Alicia","family":"Lew","sequence":"first","affiliation":[{"name":"1Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"House","sequence":"additional","affiliation":[{"name":"2Department of Pediatrics, Dartmouth Health Children\u2019s and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Flaherty","sequence":"additional","affiliation":[{"name":"3Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Ritter","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bren","family":"Botzheim","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan R.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Critical Care, Department of Pediatrics, Stanford 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