Emergency physician practice and steroid use in the management of acute exacerbations of asthma

This study seeks to determine patterns of emergency physician (EP) practice regarding steroid use in the management of acute asthma attacks in the eme rgency department (ED), and to compare practices of academic and private pr actice EPs. Two hundred eight questionnaires were mailed to academic and pr ivate practice EPs. The survey requested information regarding the preferre d initial route (oral or intravenous) for steroid administration; the initi al dose of steroid; the preferred steroid regimen for outpatient management ; and whether or not inhaled steroids were routinely prescribed at the time of discharge. The overall response rate was 74%; 91% for the academic EPs and 56% for private practice EPs. Sixty-five percent (99/143) of all EPs us ed the intravenous route for their initial dose of steroids. A significantl y greater percentage of private practice EPs (45/58 or 78%) used intravenou s steroids compared with academic EPs (54/95 or 57%; P = .009). A total of 41% (63/153) of EPs used a tapering steroid regime for outpatient therapy; a significantly greater percentage (34/58 or 59%; P = .0006) of private pra ctice EPs used a tapering regimen of steroids compared with academic EPs (2 9/95 or 31%). A total of 32%(31) academic and 34% (20) private practice EPs prescribed inhaled steroids as part of their routine discharge instruction s. Emergency physician practice patterns regarding initial steroid route of administration and dose, and outpatient-dosing regimens are variable. Only a minority of EPs prescribe steroid metered dose inhalers as part of their outpatient management of asthma. Copyright (C) 2001 by W.B. Saunders Compa ny.