474 - Awareness of Updated National Asthma Guidelines and Controller Medication Prescription Habits Among Pediatric Emergency Department Physicians

Publication Number: 474.3924

Andrew D. Fowler, Emory University School of Medicine, Atlanta, GA, United States; Anne Fitzpatrick, Emory University School of Medicine, Atlanta, GA, United States; Claudia R.. Morris, Emory University School of Medicine, Atlanta, GA, United States

Background: Daily inhaled corticosteroids (ICS) plus as needed short acting Beta agonists (SABA) have long been a mainstay of the outpatient management of asthma. However, over the last two decades, there has been growing evidence that combo inhalers containing both ICS and long-acting beta agonists (ICS/LABA) could provide superior control. In 2023, the Global Initiative for Asthma (GINA) guidelines strengthened recommendations for emergency department (ED) providers and explicitly recommended that ICS/LABA be prescribed at time of discharge from the ED after asthma exacerbation for those ages ≥6.

Objective: The purpose of this study was to determine provider understanding of the 2023 GINA Guidelines by assessing practice habits, confidence, and agreement with the guidelines. Secondary endpoints included prescribing rates of ICS inhalers and ICS/LABA inhalers.

Design/Methods: This was an observational, cross-sectional survey distributed via email to PEM providers at a large, high volume tertiary care children’s hospital. Descriptive analysis was performed, and multivariate analysis is ongoing.

Results: A total of 94 providers completed the survey, 88 physicians and 6 APPs. While 83% agreed that ED providers should prescribe ICS inhalers at time of discharge, only 37% thought the same about ICS/LABA inhalers (with 53% being neutral). Despite 83% agreeing that ED providers should prescribe ICS inhalers at time of discharge, only 51% reported doing so more than half of the time. When asked if they thought the majority of patients seen in the ED for asthma exacerbation would benefit from starting an ICS/LABA, 17% agreed, 66% were neutral, and 17% disagreed. 36% of providers reported they knew of the 2023 GINA guidelines and 66% reported being at least slightly familiar with single maintenance and reliever therapy (SMART), but 85% of providers reported they were not at all confident or only slightly confident in their ability to properly dose ICS/LABA inhalers. Only 4% of providers reported regularly prescribing ICS/LABA inhalers and 57% reported never doing so.

Conclusion(s): ED providers are much more comfortable with prescribing ICS inhalers than ICS/LABA inhalers and report doing so at a much higher rate. As the updated recommendations are a major shift in the outpatient management of asthma, it is not surprising that even providers who are aware of the new guidelines are not as comfortable prescribing ICS/LABA inhalers. More work needs to be done to educate ED providers on SMART therapy and how to prescribe ICS/LABA inhalers.