Should We Rx Inhaled Steroids for Asthma?

June 20, 2023

Written by Vivian Lei

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In this study, only 6% of asthma patients discharged from the ED received a prescription for inhaled corticosteroids and only 14% had any outpatient follow-up within 30 days of their ED visit. Patients who were Hispanic, uninsured, and privately insured had the lowest odds of receiving an ICS prescription from the ED.

Why does this matter?
Asthma-related visits to the ED are common and disproportionately affect patients of lower socioeconomic status and communities of color. Inhaled corticosteroids (ICS) are recommended in the management of persistent asthma and are shown to be effective in preventing asthma exacerbations and ED visits. However, ICS prescription rates from the ED appear to be low despite many patients experiencing barriers to accessing primary care follow-up.

A role for ED discharge asthma controller medications
In this retrospective observational study of adult patients seen over a 2-year period at five hospitals in New York City within an academic health system, researchers identified 2,999 patients seen and discharged from an ED for asthma with no prior prescription for an ICS. An ICS was prescribed in only 6% of all visits. Patients had a higher odds of receiving an ICS prescription if they received an ICS in the ED as part of their treatment (OR 9.96, 95%CI 8.08-12.27) or if they received a prescription for a beta-agonist at discharge (OR 2.66, 95%CI 2.09-3.38). Patients had lower odds of receiving an ICS prescription if they were Hispanic ethnicity relative to Black race (OR 0.71, 95%CI 0.51-0.99), or if they had private insurance (OR 0.75, 95%CI 0.62-0.91) or no insurance (OR 0.54, 95%CI 0.34-0.84) relative to Medicaid. Only 14% of ED visits were followed by a subsequent outpatient visit within 30 days, and 3.8% of index visits were followed by another ED visit within 30 days. One-third of ED attending physicians never prescribed a new ICS to asthma patients during the study period, highlighting variations in ED clinician practice patterns and adherence to asthma treatment guidelines.

Since the ED functions as a safety net for marginalized populations with poor access to primary care, it is important to reassess the role that emergency clinicians can have in adhering to updated asthma care guidelines regarding prescription of ICS in asthma patients.

Source
Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. doi: 10.1016/j.jemermed.2023.02.013. Epub 2023 Mar 21.