Asthma treatment varies widely between primary, specialized care

LOS ANGELES — Outpatient treatment of pediatric patients with asthma exacerbations differs significantly between primary care and specialty pediatricians, according to data presented at the 2016 American Academy of Allergy, Asthma & Immunology annual meeting.

“There were significant differences in prescribing habits of oral corticosteroids for asthma exacerbations in children between primary care physicians and asthma specialists in regards to once- vs. twice-daily dosing, length of treatment, and strength,” David R. Stukus, MD, FAAAI, an assistant professor of pediatrics in the section of allergy/immunology at Nationwide Children’s Hospital, told Infectious Diseases in Children. “Our results indicate that once-daily regimen and higher dosages (at least 2 mg/kg/day) were associated with less need for urgent follow-up evaluation within 30 days for asthma-related issues. However, the duration of treatment (greater or less than 5 days) did not have the same association.”

David R. Stukus

The researchers analyzed electronic medical records of pediatric patients diagnosed with asthma and treated with corticosteroids during 2014. Corticosteroid treatments for patients who presented to primary care centers were compared with those of patients treated at allergy and pulmonology clinics.

Study results showed that corticosteroid regimens of less than 5 days were more common among primary care when compared with specialty care (98% vs. 96%; P < .01). Primary care clinics also were more likely to prescribe lower doses with more courses (17.5% vs. 11.8%; P < .0001); primary care clinics also prescribed more once-daily regimens than did allergists and pulmonologists (70% vs. 43%; P < .0001).

Stukus and colleagues wrote that rates of ED visits within 30 days of prescription were lower among specialty care clinics (4.58 visits/100 patients vs. 7.18 visits/100 patients; P < .01)

“We [also] found that children prescribed steroids once-daily had fewer emergency department visits for their asthma within 30 days of initial prescription compared with those who received twice-daily prescriptions,” Stukus said. “In addition, doses less than 2 mg/kg/day were associated with higher rates of return visits to a prescriber’s office and ED within 30 days.” – by David Costill

Reference:
McNamara K, et al. Abstract 698. Presented at: the American Academy of Allergy, Asthma & Immunology Annual Meeting; March 4-7, 2016; Los Angeles.

Disclosure: The researchers report no relevant financial disclosures.