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Few poor kids get asthma meds after ER visit

By Amy Norton

NEW YORK (Reuters Health) - When low-income children end up in the ER with an asthma attack, few are prescribed the medication needed to prevent further attacks, a study of South Carolina children suggests.

Traditionally, ER doctors treating a child's asthma attack would tell the parents to follow-up with their regular doctor to get a prescription for "controller" medication to help prevent further attacks.

Inhaled corticosteroids, which control airway inflammation, are considered the most effective.

But studies have shown that many children with frequent asthma symptoms are not on preventive medication. So in the past few years, guidelines have encouraged ER doctors to prescribe the drugs themselves.

In the new study, researchers found that of more than 3,000 low-income South Carolina children who had an asthma attack treated at the ER, only a minority started preventive medication within the next month or two.

Less than one in five (18 percent) filled a prescription for an inhaled corticosteroid during the month of their ER visit or the month afterwards. None had been on inhaled steroids before the ER trip.

Overall, a little over a quarter of the children (28 percent) started on either an inhaled steroid or another type of preventive medication called a leukotriene modifier (brand-names like Singulair and Zyflo) in the months following the visit.

"We hope that by showing the staggeringly low rates of follow-up after ER visits for asthma, we can convince ER physicians to prescribe inhaled corticosteroids," lead researcher Dr. Annie Lintzenich Andrews, a pediatrician at the Medical University of South Carolina, told Reuters Health in an email.

The findings, which appear in the Journal of Pediatrics, are based on data from 3,435 children who were in South Carolina's Medicaid program between 2007 and 2009.

Guidelines from the National Heart, Lung and Blood Institute issued in 2007 suggest that children treated in the ER for asthma be prescribed an inhaled corticosteroid before discharge.

Traditionally, Andrews said, ER doctors have been hesitant to perform preventive care, like prescribing drugs meant for long-term use. They are trained to treat emergencies, have little time, and -- unlike a primary care doctor -- cannot follow up with patients to see how they are faring with a medication, Andrews said.

But, she noted, "inhaled corticosteroids are generally safe and have minimal side effects, making them appropriate for ER prescribing."

There's also the fact that children who end up in the ER for an asthma attack are at greatest risk of future attacks, Andrews and her colleagues point out. So preventive care is "paramount" for these children, they write.

Parents should also be aware that asthma attacks -- and trips to the ER -- are preventable, according to Andrews.

"So if your child is frequently seeing a physician for asthma in either the ER, hospital or primary care setting," she said, "ask about a daily medication to treat this chronic condition."

It's estimated that more than nine percent of U.S. children have asthma, with low-income minority children being disproportionately affected. Asthma attacks account for 217,000 ER visits each year, according to the American Academy of Allergy, Asthma & Immunology.

"We know that if asthmatics take their controller medication regularly," Andrews said, "they will have fewer asthma attacks -- translating to fewer ER visits and fewer hospitalizations."

The study was funded by a federal grant. None of the researchers reports any financial conflicts of interest.

SOURCE: http://bit.ly/ndtpOr Journal of Pediatrics, online September 1, 2011.

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