Smarter ER treatment of asthma needed

Emergency room doctors need to prescribe preventive medication for kids on Medicaid who show up with an asthma attack, concludes a new study in the Journal of Pediatrics. The authors conclusion is based on findings that only 18 percent of low-income children filled a prescription for the necessary inhaled corticosteroid treatment during the month of their ER visit or the month after.

Researchers led by a pediatrician at the Medical University of South Carolina analyzed data from 3,435 children who were in the state s Medicaid program between 2007 and 2009. The low percentage of these children who actually filled a prescription for medication that would deter future asthma attacks means that most of them would probably end up in the ER again, say the study authors. It seems that most of these children are not following up with a doctor afterward, and thus are not getting the necessary prescription.

However, ER doctors are often reluctant to write a prescription because they can t follow up with patients. But the study authors note that inhaled corticosteroids are generally safe and have minimal side effects, making them appropriate for ER prescribing. Since the children who have the kind of asthma attacks that bring them to the ER are at the greatest risk of future attacks, there is every reason for ER doctors to prescribe the appropriate medication.

This is unacceptable, says ACSH's Dr. Josh Bloom. There are several very effective therapies that prevent or minimize asthma. To send a kid home from the ER with nothing more than a rescue inhaler pretty much guarantees that he'll be back.