Background Asthma is the most common chronic dis-ease in childhood and it represents a huge burden for children and their families. Pharmacological therapy is es-sential to control symptoms and to prevent asthma epi-sodes. Periodic monitoring of airway function is necessary in asthma management, and guidelines recommend the use of spirometry at the initial assessment and after treat-ment is initiated and symptoms have stabilised, and every 1–2 years or more frequently.
Methods Data collected in healthcare administrative databases of Lombardy region, Italy, were analysed. A co-hort of 78 184 children born in 2002 in Lombardy region was followed for the first 10 years of life. Children were identified as potential asthmatics (PA) according to the following criteria, previously validated: one or more pre-scriptions of anti-asthmatic drugs (R03 group of the Ana-tomical Therapeutic Chemical classification system), with the exclusion of nebulised formulation, and at least one prescription occurring after the 5th birthday. Children re-ceiving anti-asthmatic prescriptions for two consecutive years (chronic treatment) were subsequently selected. The first anti-asthmatic drug prescription was identified as ‘index prescription (IP)’, and drug prescriptions in the 24 months after the IP were analysed with the aim to eval-uate the changes in asthma therapy. Moreover, the rate of monitoring (allergologist/pneumologist visit and/or spi-rometry testing) in the 12 months before and 24 months after the IP was estimated.
Results In all, 4475 children (6% of the sample) were identified as potential asthmatics treated for at least 2 years. 60% of PA started with one active substance (monotherapy): 38% had a prescription of a short-acting beta2 agonist (SABA), 37% of an inhaled corticosteroids (ICS) and 22% of a leukotriene receptor antagonist (LTRA). Of the subjects starting with a polytherapy, 88% received SABA+ICS. In the 24 months after the IP, 22% continued with the index active substance, 45% switched to other anti-asthmatic drugs, 19% had a step-down of the initial therapy, while 14% had an add-on. Between 12 months before to 24 months after the starting date, 33% of po-tential asthmatic children had a specialist visit and/or a spirometry testing. In particular, the rate of monitoring was 11% in the year preceding the start of the asthma therapy and 28% in the following 2 years. The percentage of monitored children was greater in children who had their IP after their 5th birthday (43% versus 22%), while no differences were found between genders. Differences existed between local health units, with an incidence of asthma ranging between 4% and 9%, and a frequency of monitoring between 17% and 54%. An inverse correla-tion was found at local health unit level between asth-ma incidence and percentage of PA with a monitoring. (rS=−0.6464)
Conclusion The initial therapy appears adherent to guidelines, even if in many cases modifica-tions were necessary to obtain optimal asthma control. The finding that only 1 out of 3 children was monitored at least once before and/or after the start of the therapy is a reason for concern and underlines the need for a better compliance to guidelines recommendations.
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