Oral Corticosteroid Prescribing for Children With Asthma in a Medicaid Managed Care Program

Farber, Harold J.; Silveira, Edwin A.; Vicere, Douglas R.; Kothari, Viral; Giardino, Angelo P.

doi:10.1542/peds.2016-4146

Cited by 38 publications

(37 citation statements)

References 14 publications

(10 reference statements)

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“…SCS exert an anti-inflammatory effect in asthmatic airways by inhibiting the production of potent pro-inflammatory mediators and by reducing the chemotaxis of inflammatory cells to the lungs [10]. Possibly because of their efficacy, relative affordability or a perception that short courses are harmless, substantial over-prescribing of SCS has been reported in both adults and children with asthma [9,11]. Emergency SCS are prescribed as part of asthma self-management plans for patients at risk of exacerbations [12]; when not correctly implemented, this may lead to incorrect use of the medication, putting patients at risk of adverse events.…”

Section: Use Of Scs In Asthma Managementmentioning

confidence: 99%

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Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Price¹,

Castro²,

Bourdin³

et al. 2020

Eur Respir Rev

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Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequences of long-term use are widely recognised, there appears to be a perception in the medical community that short courses of SCS are safe. Limited but growing evidence in the literature suggests that even very brief dosing periods (3–7 days) of SCS are enough to cause significantly negative outcomes for patients. Short courses of SCS are associated with increased risk of adverse events including loss of bone density, hypertension and gastrointestinal ulcers/bleeds, in addition to serious impacts on mental health. Strategies to improve asthma control are recommended, including: 1) as-needed combination therapies in mild asthma; 2) risk factor reduction; 3) improving adherence/inhaler technique; 4) earlier initiation of add-on therapies; 5) use of biologics in appropriate patients; 6) development of new therapies to better control the disease; and 7) widespread education of the medical community. We propose that patients and primary care physicians should consider a cumulative SCS dose of 1 g per year as a highly relevant and easy-to-recall threshold.

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Section: Use Of Scs In Asthma Managementmentioning

confidence: 99%

“…Highly accessible and available over the counter in some countries, SCS are prescribed as rescue medication and are largely self-administered at home. It is noteworthy that SCS courses are used to treat not only severe, but also moderate and even mild exacerbations and symptoms [9].…”

Section: Introductionmentioning

confidence: 99%

Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Price¹,

Castro²,

Bourdin³

et al. 2020

Eur Respir Rev

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“…Although up to 44% of the children had ≥1 OCS-dispensing event, only 28% of children had an ICS-dispensing event. 1 In a similar study of children with asthma enrolled in 85 different health care plans in the United States, the frequency of OCS-prescribing events was 23%; however, the frequency of ICS treatment was 25%. 2 In another study, Elkout et al 8 reported a frequency of OCS prescription of 16% in Scotland; however, the frequency of ICS treatment during the same time period was ∼73%, >4 times the frequency of OCS use.…”

mentioning

confidence: 99%

“…In this issue of Pediatrics, Farber et al 1 present the results of an analysis of claims data for children with asthma who were enrolled in a large managed care Medicaid and Children's Health Insurance Program from 2011 to 2016. During each of the years analyzed, 42.1% to 44.2% of the children had ≥1 event in which an oral corticosteroid (OCS) for asthma was dispensed.…”

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confidence: 99%

Corticosteroids and Asthma: Too Much or Too Little?

Cabana

2017

Pediatrics

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“…3 A data claims analysis from the Texas Children's Health Plan of 1 to <18 year olds revealed that 42.1 to 44.2% of children with asthma were dispensed at least one OCS course annually, with both higher dispensing rates and repeated OCS dispensing in children aged 1 to 4 years as compared with older children, suggesting substantial overprescribing of OCS. 4 A retrospective analysis of the Medical Expenditure Panel Study revealed 3.4 million school-aged children had an asthma exacerbation in 2013, and these children with exacerbations had 18.9 times more annual asthma-specific emergency department visits and 43.3 times more asthma-specific hospitalizations than those without an exacerbation. 5 On the basis of the nationally representative Medical Expenditure Panel Survey sample weights from 2013, the total annual health care expenditures attributable to asthma for school-aged children in the United States was $5.92 billion.…”

mentioning

confidence: 99%

Controlling the Risk Domain in Pediatric Asthma through Personalized Care

Anderson

Szefler

2018

Semin Respir Crit Care Med

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Strategies to control the risk domain of NHLBI EPR-3 (National Heart, Lung, and Blood Institute Expert Panel Report-3) asthma guidelines, which includes exacerbations requiring systemic corticosteroids, reduction in lung growth, and progressive loss of lung function, and treatment-related adverse effects, are evolving in children and adolescents. Increasing evidence demonstrates that children and adolescents with asthma are at risk of a reduction in lung growth, leading to lower lung function and potentially chronic obstructive pulmonary disease as adults. Readily available clinical biomarkers for atopy, including aeroallergen testing, total serum IgE, blood eosinophilia, and spirometry, are being utilized to phenotype difficult-to-treat pediatric patients, to assess risk for seasonal exacerbations, and to predict response to controller therapies. The Composite Asthma Severity Index is a novel, freely available scoring system to define asthma control, incorporating NHLBI EPR-3 risk and impairment domains. As new asthma controller therapies, such as tiotropium, are introduced for pediatric use, the safety of established controller therapies including inhaled corticosteroid and long-acting beta-agonist are being reexamined. Macrolide antibiotics may be an oral corticosteroid sparing alternative for the treatment of severe respiratory tract infection in preschool-aged children. Seasonally directed courses of omalizumab may provide an alternative approach to prevent fall asthma exacerbations in children. Combining these pharmaceuticals and biomarker-directed therapies provide potential new options and personalized approaches to gain asthma control in pediatric patients failing current management.

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Oral Corticosteroid Prescribing for Children With Asthma in a Medicaid Managed Care Program

Abstract: The patterns of dispensing observed suggest substantial overprescribing of OCS for children with an asthma diagnosis.

Cited by 38 publications

References 14 publications

Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Corticosteroids and Asthma: Too Much or Too Little?

Controlling the Risk Domain in Pediatric Asthma through Personalized Care

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