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Differences in Oral Corticosteroid Prescribing Regimens for Asthma Exacerbations Between Primary Care and Specialty Pediatricians
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Kara McNamara, MD, David R. Stukus, MD FAAAAI
Rationale: In the pediatric population, asthma exacerbations are a leading cause of Emergency Department(ED) visits and hospitalizations. Early treatment with systemic corticosteroids can help prevent the need for health care utilization. NHLBI asthma guidelines recommend oral corticosteroids for acute exacerbations, but offer a range of dosing regimens. There is a lack of data regarding corticosteroid prescribing regimens used for children with asthma exacerbations. 

Methods: We conducted a retrospective review of the electronic record from the primary care(PC), allergy/immunology and pulmonary outpatient clinics at a tertiary care pediatric hospital system for all patients(ages 6 months-21 years of age) with a diagnosis of asthma(ICD-9,493.xx) who were prescribed oral corticosteroids for asthma exacerbation between January 1 and December 31, 2014. Allergy/immunology and pulmonary clinics were aggregated into specialty clinics(SP) for purposes of comparison. Analyses were performed using chi-square.

Results: In 2014, there were 2450 total outpatient prescriptions(PC=1030,SP=1420) of oral corticosteroids for asthma exacerbations. Mean age(PC=6.9 years, SP=7.2 years) and gender(PC Male=58%,SP=60%) were similar. Regimens differed significantly in regard to duration <5 days; PC=1009(98%),SP=1363(96%);p<0.01. PC prescribed lower doses, with more courses <2mg/kg/day;n=180(17.5%) vs SP,n=167(11.8%);p<0.0001. PC prescribed more once daily regimens compared with SP;70%(n=730) vs 43%(n=613);p<0.0001. Rates of ED visits within 30 days of prescription were less in SP(4.58 visits/100 patients) compared with PC(7.18 visits/100 patients);p<0.01.

Conclusions: There is significant variation in treatment of asthma exacerbations in the outpatient setting between PC and SP pediatricians. Higher rates of ED visits were observed after prescriptions initiated by PC physicians. Standardization of corticosteroid regimens is important to help optimize clinical outcomes.