Health Care Practitioner Knowledge About Dosing And Side Effects Of Fluticasone Propionate Metered-Dose-Inhaler For Children With Asthma.

RATIONALE: A 6 year-old child developed Cushing’s Syndrome after 16 months of treatment with an FDA-unapproved dose (110mcg) of the inhaled corticosteroid (ICS) fluticasone propionate metered-dose-inhaler (FP-MDI) for asthma. The objective was to assess health care practitioner (HCP) knowledge about FP-MDI dosing and side effects.

METHODS: Anonymous and interactive polling was conducted using TurningPoint software and hand-held devices before and after PowerPoint presentation of the case during live meetings of HCPs across the United States. During the presentation, education about FDA-approved FP-MDI doses and side effects was provided.

RESULTS: Presentations (n=40) were delivered to 790 HCPs, including asthma specialists. Before the presentation, only 26% of HCPs knew the dose of FP-MDI that is FDA-approved for children <12 years of age (44mcg only), and only 28% were confident in their ability to detect and diagnose growth and adrenal suppression secondary to ICS in a child with asthma. After the presentation, the respective values were 97% and 89% (p<0.05). FP-MDI was the ICS with which 43% were most experienced, yet only 11% knew the Asthma Guideline-recommended medium dose of FP-MDI for 5-11 year old children (>176-352mcg daily). A high percentage (49%) indicated that between 21% and 80% of 5-11 year old children that they treat with FP-MDI receive the 110mcg dose.

CONCLUSIONS: HCPs are deficient in knowledge about FDA-approved FP-MDI doses and side effects and use FDA-unapproved doses, placing children at risk for developing serious systemic side effects. The reasons are unclear, but better methods to educate HCPs about ICS dosing and side effects are needed.