A36-08 Guideline-Discordant Inhaler Prescribing for Asthma Exacerbations at Emergency Department Discharge: Comparison Between a Tertiary Academic Medical Center and a Community Hospital
Abstract
Based on 2019 Global Initiative for Asthma (GINA) guidelines, asthma pharmacotherapy that includes inhaled corticosteroid (ICS) and formoterol or albuterol at Emergency Department (ED) discharge reduces exacerbations and improves symptom control, yet adherence to these recommendations remains variable. We aimed to (1) estimate the proportion of ED discharges for asthma with guideline-discordant inhaler prescribing and (2) compare performance between a tertiary academic medical center and an affiliated community hospital.
We performed a retrospective cohort study across two EDs in a single health system from March 2024 to March 2025. Adults (≥18 years) with an ED encounter for asthma or prior asthma diagnosis (defined using ICD-10 code J45) who were prescribed an inhaled bronchodilator and oral corticosteroids and discharged home from the ED were included in the study. We excluded non-discharged encounters (admitted, eloped) and patients with COPD or asthma-COPD overlap diagnoses. Data were extracted from EHR relational databases. The primary outcome was guideline discordance of discharge inhaler therapy, defined as discharge without: (a) ICS-formoterol; (b) ICS-albuterol; or (c) separate ICS combined with formoterol or albuterol. ICS included budesonide, mometasone, fluticasone propionate, fluticasone furoate, and beclomethasone.
Among 221 eligible ED encounters, 97 (43.9%) occurred at the tertiary academic medical center and 124 (56.1%) occurred at the community hospital.…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 45 participants or records.
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