Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma

Timothy Self, Jennifer D. Twilla, Maegan L. Rogers, Mark J. Rumbak

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

National and International Guidelines concur that inhaled corticosteroids (ICS) are the preferred long-term maintenance drug therapy for mild persistent asthma for all ages. For moderate and severe persistent asthma, ICS are essential to optimal management, often concurrent with other key therapies. Despite strong evidence and consensus guidelines, ICS are still underused. While some patients who are treated in the emergency department (ED) have intermittent asthma, most have persistent asthma and need ICS for optimum outcomes. Failure to initiate ICS at this critical juncture often results in subsequent lack of ICS therapy. Along with a short course of oral corticosteroids, ICS should be initiated before discharge from the ED in patients with persistent asthma. Although the NIH/NAEPP Expert Panel Report 3 suggests considering the prescription of ICS on discharge from the ED, The Global Initiative for Asthma (GINA) 2008 guidelines recommend initiation or continuation of ICS before patients are discharged from the ED. The initiation of ICS therapy by ED physicians is also encouraged in the emergency medicine literature over the past decade. Misdiagnosis of intermittent asthma is common; therefore, ICS therapy should be considered for ED patients with this diagnosis with reassessment in follow-up office visits. To help ensure adherence to ICS therapy, patient education regarding both airway inflammation (show airway models/colored pictures) and the strong evidence of efficacy is vital. Teaching ICS inhaler technique, environmental control, and giving a written action plan are essential. Lack of initiation of ICS with appropriate patient education before discharge from the ED in patients with persistent asthma is common but unfortunately associated with continued poor patient outcomes.

Original languageEnglish (US)
Pages (from-to)974-979
Number of pages6
JournalJournal of Asthma
Volume46
Issue number10
DOIs
StatePublished - Dec 21 2009

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Hospital Emergency Service
Adrenal Cortex Hormones
Asthma
Guidelines
Patient Education
Medicine in Literature
Therapeutics
Office Visits
Emergency Medicine
Nebulizers and Vaporizers
Diagnostic Errors
Prescriptions
Teaching
Inflammation
Physicians

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma. / Self, Timothy; Twilla, Jennifer D.; Rogers, Maegan L.; Rumbak, Mark J.

In: Journal of Asthma, Vol. 46, No. 10, 21.12.2009, p. 974-979.

Research output: Contribution to journalReview article

Self, Timothy ; Twilla, Jennifer D. ; Rogers, Maegan L. ; Rumbak, Mark J. / Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma. In: Journal of Asthma. 2009 ; Vol. 46, No. 10. pp. 974-979.
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