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Abstract
BackgroundAsthma management guidelines recommend a stepwise approach to instituting and adjusting anti-inflammatory controller therapy for children with asthma. The objective of this retrospective observational study was to describe prescribing patterns of asthma controller therapies for children in a primary care setting.MethodsData from the UK General Practice Research Database were examined for children with recorded asthma or recurrent wheezing who, from September 2006 through February 2007, were ≤ 14 years old at the time of a first asthma controller prescription after ≥ 6 months without a controller prescription. We evaluated demographic characteristics, asthma duration, comorbidities, asthma-related health care resource use, and prescribed daily dose of controller medication. In addition, physicians for 635 randomly selected patients completed a survey retrospectively classifying asthma severity at the prescription date and describing therapy and health care utilization for 6 prior months.ResultsWe identified 10,004 children, 5942 (59.4%) of them boys, of mean (SD) age of 8.0 (3.8) years. Asthma controller prescriptions were for inhaled corticosteroid (ICS) monotherapy for 9059 (90.6%) children; ICS plus long-acting β2-agonist (LABA) for 698 (7.0%); leukotriene antagonist monotherapy for 91 (0.9%); ICS plus leukotriene antagonist for 55 (0.6%); and other therapy for 101 (1.0%), including 45 (0.45%) children who were prescribed LABA as monotherapy. High doses of ICS (> 400 μg) were prescribed for 44/2140 (2.1%) children < 5 years old and for 420/7452 (5.6%) children ≥ 5 years. Physicians reported asthma severity as intermittent for 346/635 (55%) patients and as mild, moderate, and severe persistent for 159 (25%), 71 (11%), and 11 (2%), respectively (severity data missing for 48 [8%]). The baseline characteristics and controller therapy prescriptions of the survey cohort were similar to those of the full cohort.ConclusionsPhysician classifications of asthma severity did not always correspond to guideline recommendations, as leukotriene receptor antagonists were rarely used and high-dose ICS or add-on LABA was prescribed even in intermittent and mild disease. In UK primary care, monotherapy with ICS is the most common controller therapy at all levels of asthma severity.
Highlights
Asthma management guidelines recommend a stepwise approach to instituting and adjusting antiinflammatory controller therapy for children with asthma
Full cohort and survey cohort-demographic and clinical characteristics at baseline We identified 10,004 children 0-14 years old in the General Practice Research Database (GPRD) who were prescribed asthma controller therapy between September 1, 2006, and February 28, 2007, and who had no controller prescription during the prior 6 months
We found that physician classifications of asthma severity did not always correspond to guideline recommendations for prescribing controller therapy
Summary
Asthma management guidelines recommend a stepwise approach to instituting and adjusting antiinflammatory controller therapy for children with asthma. The objective of this retrospective observational study was to describe prescribing patterns of asthma controller therapies for children in a primary care setting. Asthma usually begins in the first years of life and is the most common chronic disease of childhood in developed countries [1,2]. International and British asthma management guidelines recommend a stepwise approach to instituting and adjusting daily controller (preventer) anti-inflammatory therapy, beginning with the dose of inhaled corticosteroid (ICS) appropriate to the severity of asthma [6,7,8,9]. Short-acting bronchodilators are recommended for relief of mild intermittent asthma and should always be available to treat asthma symptoms as needed for children with persistent asthma who are using regular controller therapy [6,7,8,9]
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