Use of a validated asthma questionnaire to increase inhaled corticosteroid prescribing in the pediatric emergency department

Abstract

Background

Asthma guidelines recommend assessment of asthma control and treatment with an ICS when appropriate. Children seen for asthma in the ED often have poorly controlled asthma. Validated questionnaires are rarely used in the ED and ICS are prescribed at less than 5% of ED asthma encounters, leaving many children at risk for continued poor outcomes.

Objective

To determine if use of a validated asthma questionnaire can increase the proportion of children who receive an ICS prescription during an ED asthma visit.

Methods

We administered a validated asthma questionnaire (Pediatric Asthma Control and Communication Instrument-ED version [PACCI-ED]) to parents of children 2 − 17 years old presenting for asthma care at a large, urban, academic pediatric ED. Based on national asthma guidelines, the PACCI-ED results were used to determine ICS dose recommendations. ED physicians reviewed the PACCI-ED results and ICS dose recommendations and chose whether to prescribe an ICS upon discharge. ICS prescribing rates during the intervention period were assessed via medical record review and compared to historical controls. We also surveyed parents to examine the association of sociodemographic factors with receipt of an ICS prescription, and surveyed physicians regarding their prescribing decisions.

Results

Thirteen physicians and seventy-nine children participated. Historically, the ICS prescribing rate for asthma exacerbations discharged from the ED was 13%. The intervention increased ICS prescribing to 56% (p < 0.001). Children with ≥2 asthma exacerbations in the prior year (p < 0.02) and those with moderate-severe persistent asthma (p < 0.02) were more likely to receive an ICS prescription. There were no statistically significant differences in ICS prescribing by sociodemographic characteristics.

Conclusion

A validated asthma questionnaire increased ICS prescribing for children presenting for to the ED for asthma care. Additional strategies are needed to promote prescribing in this setting and ensure that all eligible children receive guideline-based asthma care.

Keywords:

• Pediatrics
• treatment
• control/management
• morbidity and mortality
• prevention

Acknowledgements

GAURANTOR: SO is the guarantor of the study and accepts responsibility of the content of the manuscript.

Author contributions

BR, LT, KP, TC, SO contributed substantially to study design, data analysis and interpretations and writing of the manuscript. FB, JH, and PS contributed to data analysis and interpretation and writing of the manuscript.

Declaration of interest

There are no conflicts of interest for the authors.

Other contributors

Research Associates: Anita Schmidt, Sofronia Munoz

Research Assistants: Chloe Holifield, Jessica Flores-Vasquez, Patricia Alvarez

Students: Stephanie Hernandez, Rafael Garibay Rodrίguez

Additional information

Funding

This work was supported by American Thoracic Society.