P0297 - Primary Care Provider Corticosteroid Choice and Clinical Outcomes for Children with Acute Asthma Exacerbations

Background: There is variability in primary care provider (PCP) oral corticosteroid (OCS) preferences for treatment of children with acute asthma exacerbations. However, the impact of PCP steroid treatment choices on clinical outcomes has not been evaluated.

Objective: To evaluate clinical outcomes in children with acute asthma exacerbations treated with prednisone/prednisolone versus dexamethasone at their primary care clinic.

Methods: Retrospective cohort study of children ages 3-9 years in the Colorado All Payers Claim Database with a primary care clinic visit for asthma and an associated OCS prescription fill between January 22, 2013 and June 26, 2019. Index clinic visits were within 7 days from any prior clinic visit, ED visit or hospital admission for asthma. Visits for children with diagnosis of croup or history of complex chronic condition, and visits with prescription fills for both types of OCS on same day as index visit were excluded. The primary outcome was need for subsequent ED visit or hospital admission for asthma within 7 days of the index clinic visit. Demographics, season of index visit, asthma health services characteristics and need for additional OCS prescription fills were assessed. Multivariable logistic regression was used to evaluate the association between type of initial OCS prescription fill and the primary outcome.

Results: There were 3355 index clinic visits for asthma for 1969 children during the study period. Sixty-two percent were male, 66% were 3-4 years old, 55% were non-Hispanic, 60% were unknown/unspecified race, and 74% had Medicaid insurance (Table 1). While dexamethasone prescriptions for asthma were increasing per year, prednisone/prednisolone remains the most commonly prescribed OCS by PCPs (85%). Prednisone/prednisolone was associated with younger age (p<0.01), Medicaid insurance (p<0.01) and earlier prescription fill (p<0.01). Three percent of clinic visits had additional OCS prescription fills during the 30 days post-index clinic visit (Figure 1). Prednisone/prednisolone was the most common additional OCS prescribed, regardless of type of initial OCS prescribed. After index clinic visit, 2% required an ED visit and 1% required hospital admission for asthma within 7 days. Controller use, prior ED visits for asthma, season, and year were associated with subsequent ED visit or hospital admission for asthma within 7 days. After adjusting for these covariates, there was no significant association between type of OCS prescribed and subsequent ED visit or hospital admission.

Conclusion: Our study corroborates studies performed in the emergency setting demonstrating no differences in clinical outcomes by type of OCS prescribed. With reports of better adherence and cost savings compared to prednisone/prednisolone, dexamethasone may be the preferred steroid in the primary care setting. This study informs evidence-based changes to PCP practices and standardization of OCS prescribing practices across healthcare settings.