Frequency of Prescription of Inhaled Corticosteroids to Children with Asthma in US Emergency Departments

Objectives: This study examined how frequently inhaled corticosteroids (ICS) are prescribed at discharge in U. S. emergency departments (EDs) for children presenting with asthma exacerbations. Methods: This was a secondary analysis of the 2005-2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) database for ED visits by children 2 to 21 years old with acute respiratory symptoms and a diagnosis of asthma exacerbation. The authors determined the proportion of visits with an ICS prescription at discharge, and the associations between demographic, clinical factors, and ICS prescriptions were analyzed using logistic regression. Results: Between 2005 and 2007, there were 2,288,874 estimated visits by children 2 to 21 years old to U. S. EDs with asthma exacerbations, and ICS were prescribed at discharge at 4.0% of these visits (95% confidence interval [CI] = 2.4% to 5.5%). In the logistic regression model, ICS were more likely to be prescribed in the fall (adjusted odds ratio [OR] vs. spring 3.3; 95% CI = 1.0 to 11.0). Otherwise, there were no pertinent demographic or clinical factors associated with ICS prescription. Conclusions: Inhaled corticosteroids are infrequently prescribed for children with asthma at discharge from U. S. EDs. Other than the fall season, there are no identified demographic or clinical factors associated with the likelihood of ICS prescriptions. ED clinicians should consider interventions to increase ICS prescriptions for children with persistent asthma. ACADEMIC EMERGENCY MEDICINE 2011; 18: 767-770 (C) 2011 by the Society for Academic Emergency Medicine