Registrants often rely on medical applications such as UpToDate when prescribing medication and managing clinical conditions. The Inquiry Committee recently investigated a complaint where the management of pediatric asthma was in question. A seven-year-old child attended a walk-in clinic with respiratory symptoms and a background history of asthma. The child was subsequently assessed as having an asthma exacerbation and was prescribed Symbicort.
In this case, the registrant reviewed information about Symbicort (budesonide/formoterol) dosages in pediatrics on UpToDate. Subsequently, they informed the patient’s family that Symbicort could be used in children five to 11 years of age. The family, along with the patient, consented to the proposed treatment plan.
Symbicort contains a beta agonist, formoterol, as well as a steroid, budesonide. UpToDate is an application designed and updated by a corporation based in the United States. As such, the information referenced by the registrants was specific to a formulation of Symbicort available in that country. This specific formulation contains a lower dose of budesonide (80 micrograms), and formoterol (4.5 micrograms) compared to the Symbicort available in Canada (100 micrograms of budesonide and 6 micrograms of formoterol).
BC Guidelines on the management of pediatric asthma1 state that Symbicort can be used in ages six to 11 when regular inhaled corticosteroids use is insufficient in controlling symptoms. UpToDate states that Symbicort (USA formulation) can be used in maintenance as well as reliever therapy in children aged 4 to 11 years. As a result, there is a two-year discrepancy between the BC guidelines and UpToDate information which can lead to confusion and inadvertently prescribing differently than intended.
The College acknowledges that UpToDate is a valuable and widely used resource for registrants and does not discourage its use. However, registrants should be mindful that UpToDate is an USA-based application and differences in approved populations, formulation, and clinical application may differ from standards in British Columbia. If registrants have any questions, they may wish to contact the College.
References
- https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/asthma-children