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

Abstract

This study seeks to determine patterns of emergency physician (EP) practice regarding steroid use in the management of acute asthma attacks in the emergency department (ED), and to compare practices of academic and private practice EPs. Two hundred eight questionnaires were mailed to academic and private practice EPs. The survey requested information regarding the preferred initial route (oral or intravenous) for steroid administration; the initial 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 used the intravenous route for their initial dose of steroids. A significantly greater percentage of private practice EPs (45/58 or 78%) used intravenous 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 practice EPs used a tapering regimen of steroids compared with academic EPs (29/95 or 31%). A total of 32%(31) academic and 34% (20) private practice EPs prescribed inhaled steroids as part of their routine discharge instructions. 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.