Outpatient Medication Prescribing Patterns in Bronchopulmonary Dysplasia: A Survey of Clinical Practices and Challenges

Objective: To understand the prescribing patterns and clinical practices of providers for infants and children with bronchopulmonary dysplasia (BPD) in the outpatient clinic setting. Methods: We conducted a survey of BPD Collaborative programs from diverse geographic areas inside and outside the United States from January 2025 through March 2025. Results: Twenty-nine of 45 centers in the BPD Collaborative completed the survey, including 27 from the U.S. and 2 from other countries. The majority of respondents identified as pediatric pulmonologists (72.4%). Most healthcare providers endorsed that patient symptomatology was a major driver of decision making (79.3%) and greater BPD severity correlated with a higher likelihood of medication use. Beta-agonists and inhaled corticosteroids (ICS) were the most commonly prescribed medications across all levels of severity. While prescriptions for pulmonary hypertension (PH) medications and diuretics decreased with age, use of inhaled medications persisted or increased in frequency. Challenges obtaining medications included insurance authorization issues (69.0%) and medication costs (51.7%). Adherence to therapy was a concern for over half of BPD programs. Conclusions: Despite limited evidence for outpatient pharmacotherapy in children with BPD, we identified consistent cross-center practice patterns. Providers reported that while the utilization of therapies was associated with higher BPD severity and greater respiratory support, medications were prescribed across the spectrum of disease severity. Treatment practices varied by age group and were often hindered by common barriers to accessing medications. These findings underscore the need to revise clinical guidelines to enhance long-term outpatient pharmacotherapy for infants and children with BPD.