Oral corticosteroid prescribing patterns for severe exacerbations of airways disease

<bold>Background:</bold> Asthma and COPD exacerbations requiring hospitalization are treated with high-dose oral corticosteroids (OCS). OCS are associated with significant short and long-term risk of harm and improving OCS stewardship in airways disease is an international priority for patients and clinicians. However, little is known about prescribing patterns for airways disease exacerbations and how these compare to doses recommended in international guidelines <bold>Aim:</bold> To describe OCS prescription patterns in patients hospitalized with asthma and COPD exacerbations and determine % of cases in which cumulative OCS dose is “Higher Than usual Recommended” (HTR) in guidelines <bold>Methods:</bold> Drug charts and discharge summaries from Feb-Apr 2022 were reviewed to determine total cumulative OCS doses prescribed for patients admitted with asthma and COPD exacerbations to a secondary care respiratory centre. Strong indications for HTR OCS dose defined as severe attacks, unstable symptoms, weaning or recent OCS course <bold>Results:</bold> Mean cumulative OCS dose prescribed for asthma exacerbation episodes was 403.9mg (SD 217.8mg, range 40-980mg). 45/90 (50%) asthma exacerbations received >350mg prednisolone with 13/45 (29%) having strong indications for HTR OCS dose. 29/45 (64%) were prescribed weaning OCS courses. Median cumulative OCS dose prescribed for COPD exacerbation episodes was 210mg (IQR 238.8 mg, range 30-645mg). 47/72 (65%) COPD exacerbations received >150mg prednisolone with 21/47 (45%) having strong indications for HTR OCS dose. 30/45 (67%) were prescribed weaning OCS courses. <bold>Conclusion:</bold> OCS prescribing for asthma and COPD exacerbations varied markedly. Significant numbers of patients may be prescribed excessive cumulative OCS doses