Capturing total steroid burden in patients with atopic dermatitis and asthma

Background: The cumulative burden of cutaneous, inhaled, intranasal and systemic corticosteroids (CS) in individual patients should be routinely assessed. Methods: Our monitoring tool collected data on CS type, potency, frequency, side effects, interventions and patient counseling in every encounter. Results: 82 AD patients had 151 encounters. Severe AD had more side effects than those without (68.18% vs 41.67% respectively, P < 0.0333). Those with higher TSB had more side effects overall (p < 0.0493). There was also significant positive correlation with higher TSB and the overall number of side effects (p < 0.0116). 101 asthmatics had 193 encounters. Over 50% of asthma patients had other CS. Severe asthmatics had more side effects than those without (62.5% vs 20.8%, p < 0.0001). Patients with higher TSB had more side effects overall (p < 0.0001). There was also significant positive correlation with a higher TSB and the overall number of side effects (p < 0.0001). 80% of AD and 90% of asthma patients were satisfied with the counseling. The EHR in AD and asthma resulted in counseling in 89% and 93% respectively and real-time intervention in 27.8% and 3% respectively. Although patients with side effects had more dose adjustments, those without side effects also warranted adjustments. Physician surveys demonstrated improved satisfaction with the EHR tool over time, and minimal impact on visit time. Conclusion: The utilization of our EHR monitoring tool allows for the identification and tracking of TSB in patients, associated side effects and leads to real-time physician intervention.