Background

Asthma exacerbations requiring hospitalisation are treated with high-dose oral corticosteroids (OCS). Guidelines suggest tapering OCS to avoid adrenal insufficiency in patients whose OCS course exceeds 2 weeks, or who take maintenance OCS. However, increased cumulative OCS dose is associated with side effects.

Aim

Compare OCS tapering after asthma exacerbation to guidelines and identify if tapering improves outcomes.

Methods

Asthma exacerbation discharge summaries from May to Oct 2021 were reviewed. Tapering OCS patients were matched to patients with abrupt OCS cessation by admission date. Taper and abrupt patient data were compared using hospital and primary care electronic health records.

Results

44 of 318 (13.8%) asthma exacerbation episodes received tapering OCS. Median duration of highest dose OCS was not significantly different between taper (7 days) and abrupt (6 days) groups. 4/44 taper and 1/44 abrupt patients had an acute OCS course >14 days. 10/44 taper and 13/44 abrupt patients had received OCS ?14 days pre-admission. 13/44 taper and 4/44 abrupt patients were prescribed maintenance OCS. Overall 17/44 (39%) taper and 6/44 (14%) abrupt patients met guideline criteria for OCS taper.

Taper patients had longer hospital admission (p=0.004) and more asthma admissions in the preceding 6 months (p=0.004) compared to abrupt patients. There was no difference in blood eosinophils. Median [IQR] days from completion of OCS to next exacerbation was no different between taper (69 [33-152]) and abrupt (71 [32-143]) groups (p=0.95).

Conclusion

Clinicians often prescribe tapering OCS outside of guideline recommendations. Tapering OCS was not associated with increased time to next exacerbation.