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No clinical practice guideline recommends systemic corticosteroids for outpatients with acute respiratory tract infections (ARTIs) who do not have comorbid asthma or chronic obstructive pulmonary disease (COPD), but they probably are prescribed commonly anyway. Using a national, community-based, ambulatory care database, researchers assessed receipt of corticosteroid prescriptions in about 107,000 adults with ARTIs in 2012 and 2013; in addition, a Louisiana healthcare system database was used to identify corticosteroid injections in about 33,000 adults with ARTIs in 2014. ARTIs were defined as upper respiratory infections, otitis, sinusitis, pharyngitis, bronchitis, allergic rhinitis, influenza, or pneumonia. Patients with asthma or COPD were not excluded, but only ARTI diagnoses were used for inclusion in the cohort.
Nationally, nearly 11% of patients with ARTIs received corticosteroid prescriptions. Corticosteroid prescriptions for ARTIs varied widely by region, from about 14% in the South to 8% in the Midwest. In the local Louisiana database, 23% of patients received corticosteroid injections. Injection use varied widely among physicians in the local database: 17% of physicians never gave an injection, whereas 13% of physicians provided injections to more than 40% of their ARTI patients.
Dvorin EL et al. High frequency of systemic corticosteroid use for acute respiratory tract illnesses in ambulatory settings. JAMA Intern Med 2018 Feb 26; [e-pub]. (http://dx.doi.org/10.1001/jamainternmed.2018.0103)
Comment
It is possible that a small proportion of this corticosteroid use reflects appropriate prescribing for patients with ARTI-provoked exacerbations of comorbid asthma or COPD. Otherwise, no evidence supports corticosteroid benefits in ARTIs, and adverse effects of corticosteroids are common and potentially serious (including tragic, albeit rare, cases of avascular necrosis of the femoral head).