Should oral steroids be routinely supplied to prevent asthmatic relapse?

Cleveland Asthma is a chronic respiratory condition frequently seen in primary care, accident and emergency departments, inpatient hospital environments and presenting to the ambulance service (Bahadori et al, 2009). The prevalence is growing worldwide which is increasing costs to over a billion pounds per year in the UK National Health Service (Bahadori et al, 2009; Mukherjee et al, 2014). Recent recommendations from the National Review of Asthma Deaths (NRAD) (Levy et al, 2014) have recognised the significant burden of associated morbidity, amongst avoidable factors that commonly contribute towards asthma deaths. The review found that of all patients who suffered a fatal asthma exacerbation 10% (n=195) had been seen and discharged by a healthcare professional within the previous 28 days.

The NRAD have also expressed concerns regarding the underuse of both inhaled and oral steroids in asthma, in particular, under-prescribing of all types of preventer medication (Levy et al, 2014). This practice has changed very little in the sixteen years since delayed prescribing of oral steroids was reported by Janson et al (1998) despite the vast quantity of newer guidelines and research published since then intended to guide clinical practice. Using a patient case study (Box 1) this essay will critique and evaluate the current literature to form evidence based treatment recommendations applicable to the example patient scenario. There is a high incidence of viral and allergic asthma (Rowe et al, 2004) associated with frequent relapse statistics and a slow initiation of steroids by clinicians. This gives grounds to investigate whether oral steroids should be routinely supplied to post-exacerbation asthmatics to prevent relapse.