The Burden of Laryngeal Cleft in Children With Refractory Asthma: A 10‐Year Multicenter Experience

Introduction Uncontrolled asthma and chronic cough are prevalent pediatric respiratory conditions frequently associated with delayed diagnosis of structural anomalies such as laryngeal cleft (LC). LC can exacerbate respiratory symptoms via chronic aspiration and recurrent infections, complicating asthma management. The study objective was to compare demographic and clinical characteristics of children with LC and asthma or chronic cough and evaluate the impact of LC diagnosis and treatment on health care utilization. Methods Retrospective review of children with LC and uncontrolled asthma or chronic cough across five Nemours Children's Health sites from 2014 to 2024. Patients underwent diagnostic laryngoscopy/bronchoscopy and swallow studies. Health outcomes, including antibiotic and systemic steroid use and respiratory‐related hospitalizations, were compared pre‐ and post‐LC treatment. Subgroup analyses were performed for children under and over 2 years old. Results Among 53 patients, children with asthma were significantly older than those without asthma (median age 28.5 months vs. 13 months, p = 0.001). Type 1 LC predominated in both groups. Children with asthma demonstrated greater respiratory health care utilization, more frequent antibiotic use (52% vs. 16%, p = 0.01), and greater hospital admissions. LC treatment reduced antibiotic use but did not significantly reduce overall respiratory health care utilization in children with asthma. Subgroup analyses mirrored full cohort trends, with persistent post‐treatment respiratory burden in children with asthma. Conclusions Children with asthma and LC demonstrate greater respiratory morbidity and health care utilization, both before and after LC repair. Multidisciplinary care and targeted asthma management remain essential even after anatomical correction.