The use of a short course of oral corticosteroids (OCS), or steroid burst, is standard practice in outpatient management of acute asthma exacerbations. Although there are published guidelines on the use of OCS in asthma exacerbations, actual practice patterns in this clinical setting are unknown. This study was designed to evaluate the pattern of OCS administration and typical total OCS burst doses used in different physician groups.
A Web-based survey was administered to pulmonologists (n = 150), allergists (150), primary care physicians (155), and pediatricians (150) to assess the physician's typical pattern of OCS administration and total burst dose used in treating an outpatient asthma exacerbation.
Although there was no dominant pattern of OCS prescribing, the most common pattern (39%) was with a fixed, single daily dose with no taper. The total dose in prednisone equivalents ranged from 143 to 220 mg and the treatment duration ranged from 5.0 to 8.2 days among physician groups treating patients ≥ 12 years. The distribution of the total burst dose varied widely in all physician groups; the dose for physicians treating patients ≥ 12 years ranged from 5 to 600 mg per burst (median: 160, IQR: 100–280).
Although there are published guidelines on the use of OCS in the outpatient management of asthma exacerbations, this analysis indicates that there is wide practice variation. Further studies are needed to explore outcomes in relation to practice pattern to determine optimal care.
If optimal burst therapy is designed to reduce asthma morbidity but also limit untoward effects of OCS therapy, our results suggest that better standardization is needed.
James Fish, Other The topic of this abstract does not pertain to products, etc. Dr. Fish is an employee of Genentech which provided unrestricted support to conduct the analysis.; No Product/Research Disclosure Information