Evaluation of inhaled corticosteroid (ICS) use before exacerbations in pediatric patients with asthma

Abstract Rationale NHBLI guidelines recommend chronic use of ICS as maintenance therapy in patients with mild to moderate persistent asthma. Many asthmatic patients, especially in the pediatric population, discontinue ICS use during periods when symptoms are minimal. This potentially causes asthma exacerbations leading to hospitalizations and emergency department (ED) visits. We assessed use of ICS before an asthma-related ED visit or hospitalization in pediatric patients. Methods Children aged 8 years or younger with an asthma diagnosis and pharmacy claim for an ICS were identified using a 6-month identification period (7/1/00-12/31/00) from an employer health care claims database comprising over 3.6 million patients, and followed for 360 days following the initial index ICS claim. In patients with an asthma-related ED visit or hospitalization, ICS use was examined in the time period immediately preceding the event. Results 3,334 patients with an ICS claim were identified, and there were 179 ED visits and 61 hospitalizations in the 360 days following the initial index ICS claim. Only 50 of the 179 ED visits (27.9%) and 20 of the 61 hospitalizations (32.8%) were associated with prior ICS use. Furthermore, patients were dispensed an ICS within 30 days following the ED visit or hospitalization in only 39.0% and 34.0% of cases, respectively. Conclusions Pediatric patients with an asthma-related ED visit or hospitalization are not likely to be receiving an ICS before the event. As outlined in national guidelines, these patients will benefit from persistent use of an ICS to maintain asthma control and possibly decrease ED visits or hospitalizations.