Abstract Rationale Based on 2019 Global Initiative for Asthma (GINA) guidelines, asthma pharmacotherapy that includes inhaled corticosteroid (ICS) and formoterol or albuterol at Emergency Department (ED) discharge reduces exacerbations and improves symptom control, yet adherence to these recommendations remains variable. We aimed to (1) estimate the proportion of ED discharges for asthma with guideline-discordant inhaler prescribing and (2) compare performance between a tertiary academic medical center and an affiliated community hospital. Methods We performed a retrospective cohort study across two EDs in a single health system from March 2024 to March 2025. Adults (≥18 years) with an ED encounter for asthma or prior asthma diagnosis (defined using ICD-10 code J45) who were prescribed an inhaled bronchodilator and oral corticosteroids and discharged home from the ED were included in the study. We excluded non-discharged encounters (admitted, eloped) and patients with COPD or asthma-COPD overlap diagnoses. Data were extracted from EHR relational databases. The primary outcome was guideline discordance of discharge inhaler therapy, defined as discharge without: (a) ICS-formoterol; (b) ICS-albuterol; or (c) separate ICS combined with formoterol or albuterol. ICS included budesonide, mometasone, fluticasone propionate, fluticasone furoate, and beclomethasone. Results Among 221 eligible ED encounters, 97 (43.9%) occurred at the tertiary academic medical center and 124 (56.1%) occurred at the community hospital. Overall, 160/221 (72.4%, 95% CI 66.2-77.9) patients were discharged on guideline-discordant inhaler therapy. Albuterol-only predominated among discordant discharges (127/160, 79.4%). In comparison, 61 (27.6%, 95% CI 21.7-33.5) patients were discharged on guideline-concordant inhaler therapy. Among concordant discharges, the most common regimen was ICS-formoterol (n = 45, 73.8%). Discordance differed by site, with 66.0% at the tertiary center and 77.4% at the community hospital (absolute difference 11.4%, X2 = 3.01, p = 0.083). Conclusion Most patients being treated for acute asthma exacerbation were discharged on guideline-discordant inhaler therapy, driven largely by albuterol-only regimens. The higher discordance at the community site suggests a target for future decision support, standardized discharge pathways, and feedback interventions. Patients discharged after an ED-treated asthma exacerbation represent a high-risk population with elevated rates of relapse and readmission. Building on these findings, our team will develop and implement a clinical decision support tool to improve discharge inhaler prescribing at this critical transition of care and reduce preventable exacerbations. This abstract is funded by: None
George et al. (Fri,) studied this question.