title: Initiation of an Inhaled Corticosteroid During a Pediatric Emergency Visit for Asthma: A Randomized Clinical Trial.
abstract: OBJECTIVE
  We determine whether prescribing an inhaled corticosteroid during a pediatric emergency department (ED) asthma visit increases ongoing use and improves outcomes.
  
  
  METHODS
  This randomized trial enrolled children aged 1 to 18 years, with persistent asthma not previously prescribed a controller medication, and who were being discharged after ED asthma treatment. Intervention subjects received a 1-month prescription for an inhaled corticosteroid (fluticasone or budesonide by age) in addition to standard asthma therapy and instructions given to all patients. Outcomes included filling of the intervention and subsequent inhaled corticosteroid prescriptions, asthma-related symptoms and quality of life, and follow-up rates with a primary care provider. Outcomes were assessed during telephone interviews 2 and 8 weeks after the ED visit and by review of primary care provider and pharmacy records.
  
  
  RESULTS
  One hundred forty-seven children were enrolled, and baseline measures were similar between groups. In the intervention group, 53.5% of patients filled an initial ED prescription for inhaled corticosteroid. There was no important difference between groups in subsequent filling of a primary care provider prescription (21% intervention versus 17% control; relative rate=1.24; 95% confidence interval 0.63 to 2.41). During the 2 weeks after the ED visit, intervention subjects reported reduced shortness of breath while awake and cough while asleep compared with controls. Groups did not differ by rates of primary care provider follow-up, functional limitations, or asthma-related symptoms and quality of life.
  
  
  CONCLUSIONS
  There was no difference in the proportion of patients who filled a primary care provider prescription after ED initiation of an inhaled corticosteroid. The intervention was associated with reduced reported symptoms but did not affect other asthma outcomes or primary care provider follow-up.
authors.affiliation: Baylor College of Medicine, Section of Emergency Medicine, Texas Children's Hospital, Houston, TX. Electronic address: emsampay@texaschildrens.org.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Sampayo
authors.affiliation: Department of Emergency Medicine, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: Baylor College of Medicine, Section of Emergency Medicine, Texas Children's Hospital, Houston, TX.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Zorc
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001071:Appointments and Schedules; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011788:Quality of Life; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents