Often, when these uncontrolled severe asthma patients leave urgent care, they are not going to a doctor for follow-up, assessment and then referred to an asthma specialist for treatment – a “care pathway” that should be accessible to everyone, Waserman explains.
“Clearly, if somebody’s going to an emergency department and getting two courses of oral corticosteroids, they need to be assessed to make sure that everything else has been corrected and they need a specialist.”
Oral corticosteroids along with inhaled medications on a puffer have long been an important treatment option for managing severe asthma. However, oral corticosteroids are known to increase the risk of short and long-term adverse effects, even at low doses.
And for patients without a specialist to direct their treatment, there’s the danger of returning to the ER repeatedly for oral corticosteroids.
“People don’t realize that you don’t need a huge amount of oral corticosteroids to cause trouble. So, what do we worry about? In children, they will interfere with growth,” Waserman says. “In older adults, they will cause weakening of the bones, so people can get osteoporosis and increased risk of fracture.” Some people deal with mood and sleep disturbance, diabetes and blood pressure problems can get worse, and oral corticosteroids can lead to cataracts and glaucoma in the eyes.