A new study has found that children under the age of five had a significantly higher utilization rate of oral corticosteroids (OCS) compared to children five and older, according to an article published in Pediatrics. Furthermore, this fact may be explained by a lack of inhaled corticosteroid (ICS) use in children under five, a related editorial reported.
The study analyzed 69,056 children <18 years of age with an asthma diagnosis in 2015. Of these children, 29,076 children (42.1%) had one or more incidents of OCS dispensing, while 6,849 (9.9%) had two or more and 2,265 (3.3%) had three or more.
Results found that OCS dispensing rates were highest for the children <5 years of age. Specifically, 49% of children under five (11,054 out of 22,553) had one or more OCS dispensing event compared to 38.8% children ?5 years (18,022 of 46,503).
Repeated OCS dispensing was common, and was most common for children 1 to 4 years of age, the study found. In addition:
- Most children with an OCS dispensing (81%–83%) did not have other utilization suggesting poor asthma control (excessive ?-agonist refills, emergency department visit, or hospitalization for asthma).
- OCSs were less commonly prescribed to patients whose primary care provider was a board-certified pediatrician compared with other types of primary care providers.
- There was large variation in OCS prescribing rates among pediatricians (15%–86%). There were minimal differences in asthma emergency department visits and no
According to an editorial by Michael D. Cabana, MD, MPH, of the University of California, San Francisco, a potential explanation for the high level of OCS dispensing for children under five is the fact that the OCS-prescribing frequency was so much greater than the inhaled corticosteroid (ICS)-prescribing frequency. “Asthma exacerbations requiring oral systemic corticosteroids are one of several criteria used to determine the need for ICS controller prescription, and one would expect the frequency of ICS use to increase with OCS prescription. Although up to 44% of the children had ?1 OCS-dispensing event, only 28% of children had an ICS-dispensing event.,” he wrote in the editorial published by Pediatrics.