New Year’s Resolution–Who Should start Controller Meds?

New Year’s resolution!

I don’t like New Year’s Resolutions–if I don’t do something everyday, how is a resolution going to change my priority?  Behold…I bring you good tidings of great joy…taking regular PREVENTATIVE medication works the same way! 

So what’s the issue at hand?  Patients with asthma often want to stop preventive medication for the cough & wheeze.  I often hear…I don’t need it, only to suffer from an asthma attack with their next cold.  What are some useful strategies to improve asthma care in this regard?

 From the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition: Abstract 14793. Presented October 14, 2011: 

American Academy of Pediatrics
  • Pediatricians strongly support the recommendation that emergency department (ED) physicians start asthma controller medications during an acute visit to the ED, according to research presented here at the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition.
  • Why in the emergency room?  It’s the best time to have that one-on-one discussion with asthma patients.  You have their attention.

National asthma guidelines recommend that ED physicians consider initiating long-term controller medications when children present with an acute asthma attack. We all (I mean physicians) follow the guidelines, right?  Think again!

  • Many ED doctors are reluctant to do so, lead author Esther Maria Sampayo, MD, MPH, from the University of Pennsylvania School of Medicine, Philadelphia, said in an oral abstract session.
  • “One AAP study noted that less than 20% of ED doctors actually do this,” Dr. Sampayo told Medscape Medical News. “When you ask them why, they say it’s not their role to be the pediatrician and they shouldn’t be providing long-term management.”

If you don’t know the answer….then let’s find out.  The researchers did a cross-sectional mail survey of a randomly selected national sample of pediatricians involved in providing primary care from the AAP.

  • Of the 527 pediatricians who responded to the survey, 83% reported that they feel it is appropriate for the ED physician to initiate controller medications.
  • Just 23% of pediatricians reported that their patients “almost always” follow-up within 1 month after an ED visit. Makes you wonder what else gets “missed!”
  • Half (51%) of those surveyed believe that having ED physicians prescribe controller meds in the ED will encourage patients to follow-up. 
  • The survey also asked the pediatricians what they consider to be the benefits of having ED physicians initiate asthma controller medications. Most (85%) feel that it is a “teachable moment” and represents an important opportunity to capture patients who are poorly controlled.  Strike it while the iron is hot!

    Strike When the Iron is Hot!

Noah Kondamudi, MD, an asthma specialist in the Pediatric Emergency Department of the University of Medicine & Dentistry of New Jersey in Newark, said that in his experience, more and more ED doctors are prescribing asthma controller medications when children present with acute asthma.

Here in Oklahoma, no data is available on prescribing habits of emergency room physicians for asthma controller meds or the opinion of local pediatricians.  Do I hear a study that needs to be done?

“In general, emergency room doctors would not want to add to or change the primary care doctor’s chronic disease plan. However, more and more data are showing that many asthmatic children are not on controller medication, so initiating controller therapy should make a big difference,” he said.

My thanks to Fran Lowry who is a freelance writer for Medscape.  She has disclosed no relevant financial relationships.

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