Use of corticosteroids and antibiotics for the treatment of asthma exacerbations at a quaternary care respiratory institute: A descriptive cohort study

Abstract

Rationale The Global Initiative for Asthma guidelines recommend 50 mg prednisone for 5-7 days for asthma exacerbations and avoiding antibiotics. Management following failed home action plans is not addressed. Objectives The objectives of this study were to describe management of asthma exacerbations at the Montreal Chest Institute - Day Hospital (MCI-DH). Methods We retrospectively reviewed patients presenting to the MCI-DH for asthma exacerbations from January 2019 to June 2020. Data pertaining to demographics, treatments, and adverse events were collected and presented descriptively without statistical comparison. Measurements and Main Results Most patients present to the MCI-DH with an asthma exacerbation following a failed home action plan. A total of 107 patients (130 visits) were included in the analysis. Systemic corticosteroids were initiated in 119/130 (91.5%) visits, with 30 (25.2%) patients receiving the full course as oral therapy, whereas 89 (74.8%) were transitioned to oral therapy from intravenous. A daily dose of 50 mg of prednisone was observed in 34/119 (28.6%) treatment courses. The mean total corticosteroid duration was 12 days (SD 8), with only 18/119 (15.1%) treatment courses prescribed for 5-7 days. Corticosteroids were tapered over a mean of 14 days (SD 15) in 66 (55.5%) patients. Antibiotics were initiated in 18/130 (13.9%) visits, and 5/18 (27.8%) had no documented rationale. No adverse drug events were recorded in the 90 days following treatments. Conclusions The MCI-DH serves a complex population of patients often presenting following a failed action plan. Clinical judgment appears to have led to longer course high dose corticosteroids for many. Salvage therapy following a failed action plan requires further study.