title: Practice patterns in asthma discharge pharmacotherapy in pediatric emergency departments: a pediatric emergency research Canada study.
abstract: OBJECTIVE
  The objective was to examine utilization of β2 agonists via metered dose inhalers with oral and inhaled corticosteroids (ICS) at discharge in children with acute asthma.
  
  
  METHODS
  This was a retrospective medical record review at six pediatric emergency departments (EDs) of otherwise healthy children 2 to 17 years of age discharged with acute asthma. Data were extracted on history, disease severity, and pharmacotherapy used in the ED and at discharge. The primary outcome was the proportion of children prescribed "comprehensive therapy," i.e., albuterol via metered dose inhaler (MDI) with oral and ICS.
  
  
  RESULTS
  The overall rate of comprehensive therapy was 382 of 654 (58%), which varied from 30% to 84% (p < 0.0001). A total of 570 of 575 children discharged on albuterol received MDIs. Although the rates of prescriptions for oral and ICS were both 80%, only 58% of patients without ICS on arrival were offered ICS at discharge. There was significant variation in the rates of all discharge pharmacotherapies across centers. The independent predictors of comprehensive therapy were daytime presentation (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.05 to 2.67) and "intensive stabilization" (OR = 2.33, 95% CI = 1.29 to 2.67). Seventeen patients (2.6%) were prescribed antibiotics. Children were more likely to receive antibiotics if they had moderate to severe exacerbations (OR = 2.8) or received a chest radiograph (OR = 8.4).
  
  
  CONCLUSIONS
  The overwhelming majority of children discharged from Canadian pediatric EDs with acute asthma are prescribed inhaled albuterol via MDIs. Although the corticosteroid use at discharge is higher than previously reported, utilization of new prescriptions for ICS may not be optimal. Children presenting during daytime to EDs receiving intensive stabilization are more likely to receive the albuterol/oral steroid/ICS combination.
authors.affiliation: Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. suzanne.schuh@sickkids.ca
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.forename: Amy
authors.initials: A
authors.lastname: Plint
authors.forename: Karen J L
authors.initials: KJ
authors.lastname: Black
authors.forename: Stephen
authors.initials: S
authors.lastname: Freedman
authors.forename: Robert
authors.initials: R
authors.lastname: Porter
authors.forename: Serge
authors.initials: S
authors.lastname: Gouin
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000367:Age Factors; D000420:Albuterol / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003266:Continuity of Patient Care; D016208:Databases, Factual; D004635:Emergency Medicine / Q000592:standards / Q000639:trends; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D036501:Metered Dose Inhalers; D016017:Odds Ratio; D010351:Patient Discharge; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D000420:Albuterol