Opioids for Cough and Steroids for Inflammation in Pneumonia and Sinusitis :

In this age of being good stewards of antibiotics and choosing them wisely when indicated, we sometimes forget that we need to be good stewards of other pharmacologic agents as well, especially when the evidence says they are not indicated. Two examples are opioid medications for cough suppression in acute respiratory illness and administration of steroids in the absence of documented reactive inflammatory lung disease such as seen with asthma. Phang et al (10.1542/peds.2019-3690) looked at Medicaid claims data in South Carolina for 31,838 children between the ages of 5 and 18 who met inclusion criteria for this study. They found that both opioids and steroids were used far more frequently in the emergency department (ED) versus the outpatient setting for acute respiratory illnesses. The authors also note that there are differences in prescription of these two types of drugs by race and ethnicity. In this study, for example, African American and Hispanic children were less apt to receive opioids compared to non-Hispanic whites. While this is a good thing for avoiding opioids in this situation, sadly other papers have documented similar reluctance to use opioids in African American and Hispanic children when strongly indicated. As to why the differences in use of opioids and steroids overall and why EDs use these more than ambulatory setting, check out this study.