Are oral steroids being overused for children with asthma?

Oral corticosteroids have been shown to definitively benefit children with moderate to severe asthma exacerbations. However, they show no benefit and even possible harm for children with minimal-to-mild exacerbations. Recent research using data from Texas Children’s Health Plan has found very high rates of oral corticosteroid dispensing in the past year for children with a diagnosis of asthma: close to 50% for children under 5 years, and close to 40% of children over 5 years. There was large variation in oral corticosteroid dispensing rates by pediatrician primary care providers, but no difference in asthma hospitalization rates comparing the low prescribers to the high prescribers.

Oral corticosteroids are not appropriate for cough or wheeze that is not caused by asthma. Oral corticosteroids are not appropriate for mild asthma exacerbations that will most likely resolve on their own with just symptomatic therapy. Oral corticosteroids are not appropriate if the patient has a normal oxygen saturation (≥96% on room air) and has a normal respiratory rate. Early administration of oral corticosteroids may be considered if the patient has a history of rapidly progressing, life-threatening asthma exacerbations. Prompt administration of oral corticosteroid medication is important for a moderate to severe asthma exacerbation with increased respiratory rate, nasal flaring, or accessory muscle use.

The best option is to take a tempered approach to the use of oral corticosteroids.

References:

Farber HJ, Silveira EA, Vicere DR, Kothari VD, Giardino AP. Oral Corticosteroid Prescribing for Children With Asthma in a Medicaid Managed Care Program. Pediatrics. 2017;139(5):e20164146
http://pediatrics.aappublications.org/content/early/2017/04/06/peds.2016-4146

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2017. Available from http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/

Asthma/Recurrent Wheezing Clinical Guideline Evidence-Based Guideline. Texas Children’s Hospital Evidence Based Outcome Center January 2014