Underuse of inhaled corticosteroids in adults with asthma

Despite strong evidence that inhaled corticosteroids are beneficial in trea ting asthma, a number of small studies suggest a use rate of only 34-56%. T he primary objective of this study was to determine patterns of prescribing inhaled corticosteroids for high-risk patients with asthma. Secondary obje ctives were to assess patterns of practice with respect to other agents pre scribed before and at hospital discharge, and to determine if an emergency room asthma care map at one of the study hospitals was being followed. We r etrospectively reviewed charts of 1022 patients with an acute attack of ast hma treated in the emergency roams of the Royal Alexandra Hospital and Univ ersity of Alberta Hospital from January 1, 1996, to March 31, 1997. A forwa rd stepwise logistic regression analysis was performed with the dependent v ariable defined as whether or not the patient was using an inhaled or oral corticosteroid during the index visit, and the independent variable being a ll major demographic variables. Inhaled corticosteroids were prescribed for 460 patients (52.0%) at the index visit. Overall, antiinflammatory drugs w ere prescribed for 548 patients (62.1%). An asthma care map was followed fo r 107 (16.8%) patients treated at the Royal Alexandra Hospital at the index visit. Logistic regression analysis showed that women and patients with mo re than one emergency room visit most likely were to be using inhaled or in haled plus oral corticosteroids at the index visit. Documentation of drug t herapy at discharge was poor for 42% of patients; therefore, analysis of pr actice patterns in this group was not attempted. This study shows that inha led corticosteroids were prescribed for only about one-half of patients wit h an acute asthma attack. Given this low use by high-risk patients, the nee d for programs designed to improve asthma therapy is evident.