Does HFNC Use in Bronchiolitis Up the Risk for an Asthma Diagnosis?

Featured Buzz – January 26, 2026

A recent study led by researchers from Nemours Children’s Health in Orlando, FL, suggests a link between treatment with the high flow nasal cannula (HFNC) during a pediatric hospitalization for bronchiolitis and a subsequent diagnosis of asthma.

However, the investigators are quick to note that the jury is still out on the importance of that link because HFNC tends to be more commonly used among children with more severe disease, and it is difficult to distinguish between a severity-associated risk and a treatment-associated risk.

The research was based on a retrospective review of children younger than two years old who were admitted for bronchiolitis from Jan. 1, 2015, to Mar. 4, 2024. The final analysis included 4,736 children, 43% of whom were treated with HFNC therapy during their hospital stay and 29% of whom were eventually diagnosed with asthma.

Specific findings include:

• Children in the HFNC group had increased ED acuity, bronchiolitis encounters, and 30-day hospitalization return rates than those in the non-HFNC group.
• 37% of the kids in the HFNC group went on to be diagnosed with asthma vs. 22% of those in the non-HFNC group. They also had a shorter time to diagnosis, 223 vs. 299 days.
• Children treated with HFNC were more likely to test positive for human rhinovirus/enterovirus (57.4% vs. 37.7%).
• Children who were not diagnosed with asthma were more likely to have had the respiratory syncytial virus, 57.2% vs. 33%.
• Other factors that influenced an asthma diagnosis were older age, public insurance, more hospital encounters, and hospitalization in Florida.
• After adjustment for demographic and clinical variables, HFNC use was associated with a 40% increased hazard of subsequent asthma diagnosis, but no dose-response pattern was observed.

“In this large, multicenter cohort of children hospitalized with bronchiolitis, HFNC use was associated with an increased hazard of subsequent asthma diagnosis,” concluded the authors. “Given the observational design and clinical context in which HFNC is used, this association most plausibly reflects greater underlying illness severity, rather than a direct effect of HFNC.”

That said, however, they also believe additional study is warranted to “clarify whether HFNC merely identified children at higher baseline risk or modified disease trajectory.”

The study was published ahead of print by Pediatrics Open Science.