54% of pediatric asthma caregivers familiar with oral corticosteroid long-term effects
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Key takeaways:
- Researchers captured how caregivers view oral corticosteroids via survey.
- High proportions ranked cardiovascular disease, depression/anxiety and sleep apnea as the most concerning long-term side effects.
BOSTON — Among caregivers of children with asthma, only 54% were familiar with oral corticosteroid long-term side effects, according to a poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
This poster was presented by the Allergy & Asthma Network.
“Osteoporosis, cataracts, glaucoma, infections, cardiovascular disorders and type 2 diabetes are just some of the physical comorbidities associated with long-term [oral corticosteroid] use,” Nina C. Ramirez, MD, FACAAI, FAAAAI, FCCP, adjunct faculty at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, and colleagues wrote.
Using online survey results, Ramirez and colleagues evaluated responses from 500 U.S. caregivers (66% 18 to 39 years old; 73% women; 63% white; 20% Hispanic; 52% with at least a bachelor’s degree) of a child with asthma to uncover how they view oral corticosteroids.
Notably, oral corticosteroids, short-term side effects and long-term side effects were each defined in the survey, according to the poster.
When uncontrolled asthma was identified as use of a rescue inhaler at least two times a week, at least two nocturnal awakenings for asthma in a month or at least two rescue inhaler refills in a year, most children (92%) cared for by this study population met one of these criteria.
“I was surprised to see that in 2023 we still have over 90% of these respondents with children who have less than optimally controlled asthma characterized as uncontrolled,” Ramirez told Healio.
Reflecting on the past 12 months, researchers found that asthma attacks negatively impacted education, with 78% of children missing school for this reason.
The average number of times children received treatment for asthma attack, flare or exacerbation in this time frame was 3.6, according to the poster.
In terms of oral corticosteroids, pill and liquid/syrup prescriptions were reported a similar number of times in the past 12 months by the caregivers (average, 3.3 times vs. 3 times).
When inquiring about oral corticosteroid use for treating asthma attack, flare or exacerbation, more than half (61%) thought the child’s sickness would last longer without them. Additionally, during a child’s presentation to a health care provider (HCP) with one of the three outlined adverse outcomes, the poster noted that much of the population (57%) expected a prescription, and expectation specifically for an oral corticosteroid was more common among white vs. Black and Hispanic caregivers (69% vs. 55% vs. 53%).
The belief that oral corticosteroids resulted in a “at least a moderate amount” of symptom improvement was held by 92% of caregivers, according to the poster.
A higher proportion of caregivers had familiarity with the short-term vs. the long-term side effects of oral corticosteroids (69% vs. 54%), despite the survey finding that 56% reported being told about the cumulative long-term side effects by their HCP.
After asking caregivers to express how safe they think oral corticosteroids are on a scale, researchers found an average score of 7.2, leaning closer to “safe for treating my child’s asthma” rather than “harmful to my child’s health.”
Ramirez told Healio familiarity with this treatment option for asthma flare as an effective short-term fix is one reason caregivers believe oral corticosteroids are safe.
“This is their lived experience,” Ramirez said. “So why not prescribe this medication again (and again) since it worked before.”
Another reason for this belief is trust in HCPs, Ramirez told Healio.
“For the most part, caregivers trust their HCP’s awareness about efficacy and safety and therefore accept this treatment option time and time again,” Ramirez said. “They also presume their HCP is aware of the number of times an OCS has been prescribed.”
Of the total cohort, 233 caregivers provided a response on the short-term side effects their children had after receiving oral corticosteroids. According to the poster, frequent reports included mood changes (49%), anxiety (39%) and insomnia (37%). Other side effects reported by a smaller proportion of caregivers included nervousness (30%), weight gain (28%), easy to anger (25%) and hunger (25%).
The top three frequently reported short-term side effects of oral corticosteroids also doubled as the most concerning short-term effects ranked by caregivers using a list of side effects: mood changes (44%), anxiety (43%) and insomnia (37%).
For long-term side effects, high proportions of caregivers ranked cardiovascular disease (49%), depression/anxiety (37%) and sleep apnea (23%) as the most concerning.
“Because of the choice of questions and choice of responses in the survey, caregivers of children were tasked with responding to their perception of long-term side effects to include those far more germane to adults vs. children (cardiovascular disease, type 2 diabetes mellitus, osteoporosis, cataracts, etc.),” Ramirez told Healio. “This is definitely something that should be addressed in future studies. We have to address growth, adrenal insufficiency, etc. specifically.”
Researchers further observed a greater proportion of caregivers who disagreed vs. agreed that their child had been prescribed too many oral corticosteroids by their HCP (41% vs. 37%), and Ramirez told Healio this finding was concerning but “not necessarily surprising.”
Lastly, awareness regarding the number of times oral corticosteroids have been prescribed in the past 12 months from the HCP side was believed by 84% of caregivers, according to the poster. Ramirez told Healio this finding, particularly how caregivers came to this conclusion, requires further exploration.
“My suspicion is they perceive somehow that all knowing HCP can see the number of times on their computer screen an oral corticosteroid has been prescribed,” Ramirez said. “This is far from the truth and reality.
“Perhaps the pharmacist is counting the number of prescriptions, but many HCPs are on auto pilot and not creating their needed awareness of oral corticosteroid reliance and (over)prescribing practices,” Ramirez continued. “Also, this does not even address the child taken to other providers, other clinics, other urgent care facilities, etc.”
When describing the overall results, Ramirez said the quote, “The fault, dear Brutus, is not in our stars, but in ourselves that we are the underlings,” from William Shakespeare is fitting.
“The answer is literally right under our noses,” Ramirez told Healio. “Yes, while it exists in the chest collectively, we have not been doing a good job at messaging steroid stewardship especially in the pediatric population. That’s my take after 35-plus years in the business and two fellowships later. We can and we must do a heck of a lot better! The fault is not in the stars.”
Ramirez hopes these survey findings will inspire close examination of the reader’s unique practice setting.
“The impact of these findings for the everyday clinician relates to the error of omission,” Ramirez told Healio. “Omitting key features found in a detailed history characterizing a child’s asthma control or lack thereof.
“With an appropriate assessment of their level of control and with the correct and appropriate use of anti-inflammatory controllers there will be far less need to escalate therapy to include the error of commission, committing children to systemic steroids and perhaps, unnecessarily, biologics,” Ramirez continued. “As I have mentioned, the loopholes are unfortunately numerous.”
For more information:
Nina C. Ramirez, MD, FACAAI, FAAAAI, FCCP, can be reached at nramirez@nova.edu.
De De Gardner, DrPH, RRT, RRT-NPS, FAARC, FCCP, chief research officer at Allergy & Asthma Network, can be reached at dgardner@allergyasthmanetwork.org.