Oral Corticosteroid Use for Asthma: Are We Over- or Under-prescribing Them Appropriately? :

The National Heart Lung and Blood Institutes asthma guidelines suggest the use of a short course of oral steroids for treatment of moderate to severe asthma. Yet are we using these brief oral courses for less severe episodes?  Farber et al. (10.1542/peds.2016-4146) looked at 5 years of claims data for children enrolled in a Texas Medicaid and CHIP managed care program.  While about 20% of children were noted to have asthma in this database, slightly over 40% of these children had at least one short course of oral steroids prescribed, with more younger children (ages 1-4) getting treated compared to older children.  The majority of the children receiving the steroids did not have other indicators of poor asthma control, and there was great variability in the frequency by which primary care providers used oral steroids (between 15 to 86%). So what does this mean?  Are we offering our patients too much or too little oral corticosteroids for their asthma?  To better answer that question, we asked asthma expert Dr. Michael Cabana from UCSF (10.1542/peds.2017-0598) to weigh in with a commentary to shed more light on the findings of this study. At a time when we are all trying to be good stewards of health care resources, you may find this article and commentary on use of oral corticosteroids to be quite inspiring.  Do you have a copy of the NHLBI asthma guidelines available to you and your colleagues in the office?  If not here is a link to them to assure you are using the right therapy for the right level of severity of your asthma patients.