pediatrics
December 2017, VOLUME140 /ISSUE Supplement 3

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

HJ Farber, EA Silveira, DR Vicere, VD Kothari, AP Giardino. Pediatrics. 2017;139(5):e20164146
  1. Christopher Randolph, MD
  1. Waterbury, CT

PURPOSE OF THE STUDY.

Oral corticosteroids are used for the treatment of moderate to severe exacerbations of asthma, but there is concern about overuse in pediatric populations. This study evaluated prescriptions of oral corticosteroids for children with asthma.

STUDY POPULATION.

Children with asthma ages 1 to 18 years with a diagnosis of asthma enrolled in a Medicaid Managed Care Program.

METHODS.

Claims data from 2011–2015 from the Texas Childrens’ Health Plan were examined.

RESULTS.

During the study period, up to 22% of children had an asthma diagnosis and up to 44% of the children had 1 or more prescriptions for oral corticosteroid (OCS) in each year. Children 1–4 years had the highest rate of OCS dispensation. Among those prescribed OCS, <28% had a prescription for an inhaled corticosteroid that same year. Children receiving OCS had more β-agonist prescriptions, emergency department (ED) visits, and hospitalizations compared with those who did not receive OCS. Board-certified pediatricians prescribed OCS less commonly than other primary care providers, but there was a large disparity in the rates of prescription among pediatricians (15% to 86% in 2015). There was no difference in ED visits or hospitalization rates by OCS dispensing quartile among pediatricians.

CONCLUSIONS.

OCS dispensation data for children with asthma suggest there is overuse among Medicaid-insured children.

REVIEWER COMMENTS.

Overprescription of oral steroids for respiratory symptoms, particularly for children 1–4 years of age, is not surprising, as diagnosing asthma in this age group is challenging due to the inability to perform objective diagnostic evaluation of pulmonary functions. In addition, the low rate of inhaled corticosteroid prescriptions to children with asthma is notable. The study is limited by use of claims data from a low-income population in the Texas Childrens’ Health Plan. An editorial in the same issue of the journal (Cabana M. Pediatrics. 2017;139[5]:e20170598) highlights possible reasons for overprescription of OCS as (1) regional medical practice culture, (2) regional inhalant environmental allergens and/or irritants affecting asthma morbidity, (3) lack of guidelines or recommendations, or perhaps more importantly, (4) patient or physician barriers to inhaled corticosteroid prescription and use.