Use of inhalation corticosteroids (ICS) in children with asthma in general practice

Abstract

Background:To prevent airway remodelling and the development of irreversible airway obstruction, inhaled corticosteroids (ICS) should be introduced in an early phase of the disease. Dutch guidelines recommend ICS for children with moderate to severe asthma.Aim of the study:To evaluate the use of ICS in relation to the severity of asthma.Methods:We evaluated asthma symptoms during 2 weeks, bronchial hyper-responsiveness (BHR), and the use of ICS in 74 children (age: 7–16) who were previously prescribed anti asthma medication in general practice. BHR was measured by using a Methacholine inhalation challenge test. Doubling doses of methacholine, beginning with 0.03 mg to a maximum of 1.8 mg (cumulated dose max. 3.6 mg), were administered with the Jeager Masterscope, Aerosol Provocation System (APS), medic aid side stream nebulizer. The degree of bronchial responsiveness was expressed as a PD20, a provocation dose that induces a 20% fall in FEV1 from baseline.Results:Thirty-eight children (51%) reported asthma symptoms on four or more days in their 2 weekly diary. Twenty-seven of these children (71%) had moderate to severe BHR (PD20 <300:g). Two of these children did not use ICS at all, fourteen used ICS intermittent, only eleven used ICS as a maintenance therapy.Conclusion:Our data indicate undertreatment of asthma in children. Health care providers, patients and parents should be more aware of the importance of maintenance therapy of ICS. There seems to be considerable room for improvement.