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Initiation of an Inhaled Corticosteroid During a Pediatric Emergency Visit for Asthma: A Randomized Clinical Trial
Esther M Sampayo1, Maryann Mazer-Amirshahi2, Elizabeth A Camp1
1Baylor College of Medicine, Section of Emergency Medicine, Texas Children's Hospital, Houston, TX.
Insights
Prescribing inhaled corticosteroids during pediatric emergency visits for asthma did not increase controller medication use. However, it did reduce symptoms like shortness of breath and cough in children.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Asthma is a common chronic respiratory disease in children.
- Emergency department (ED) visits for asthma exacerbations are frequent.
- Controller medication adherence is crucial for managing persistent asthma.
Purpose of the Study:
- To evaluate if initiating inhaled corticosteroids (ICS) during a pediatric ED asthma visit improves medication adherence and health outcomes.
- To assess the impact of ED-initiated ICS on subsequent prescription filling and clinical markers.
Main Methods:
- A randomized trial involving 147 children (1-18 years) with persistent asthma discharged from the ED.
- Intervention group received a 1-month ICS prescription alongside standard care.
- Outcomes measured included ICS prescription fills, symptom reporting, quality of life, and primary care follow-up via interviews and record reviews.
Main Results:
- 53.5% of the intervention group filled the initial ED ICS prescription.
- No significant difference in subsequent ICS prescription fills by primary care providers (21% vs. 17%).
- Intervention group reported reduced shortness of breath and cough within 2 weeks post-ED visit, but no differences in other outcomes.
Conclusions:
- Initiating inhaled corticosteroids in the pediatric ED did not increase overall controller medication use.
- The intervention showed a short-term benefit in reducing reported asthma symptoms.
- ED-initiated ICS did not improve primary care follow-up rates or other asthma-related quality of life measures.
Study Objective:
We determine whether prescribing an inhaled corticosteroid during a pediatric emergency department (ED) asthma visit increases ongoing use and improves outcomes.
Methods:
This randomized trial enrolled children aged 1 to 18 years, with persistent asthma not previously prescribed a controller medication, and who were being discharged after ED asthma treatment. Intervention subjects received a 1-month prescription for an inhaled corticosteroid (fluticasone or budesonide by age) in addition to standard asthma therapy and instructions given to all patients. Outcomes included filling of the intervention and subsequent inhaled corticosteroid prescriptions, asthma-related symptoms and quality of life, and follow-up rates with a primary care provider. Outcomes were assessed during telephone interviews 2 and 8 weeks after the ED visit and by review of primary care provider and pharmacy records.
Results:
One hundred forty-seven children were enrolled, and baseline measures were similar between groups. In the intervention group, 53.5% of patients filled an initial ED prescription for inhaled corticosteroid. There was no important difference between groups in subsequent filling of a primary care provider prescription (21% intervention versus 17% control; relative rate=1.24; 95% confidence interval 0.63 to 2.41). During the 2 weeks after the ED visit, intervention subjects reported reduced shortness of breath while awake and cough while asleep compared with controls. Groups did not differ by rates of primary care provider follow-up, functional limitations, or asthma-related symptoms and quality of life.
Conclusion:
There was no difference in the proportion of patients who filled a primary care provider prescription after ED initiation of an inhaled corticosteroid. The intervention was associated with reduced reported symptoms but did not affect other asthma outcomes or primary care provider follow-up.
