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How pediatricians in Spain manage the first acute wheezing episode in an atopic infant. Results from the TRAP study
J A Castro-Rodríguez1, A Escribano Montaner, J Garde Garde
1Pediatric Respiratory Medicine Dept., School of Medical Sciences, University of Santiago de Chile, Chile.
Insights
Most pediatricians use short-acting beta2 agonists for infant wheezing, but many add steroids. Management aligns with guidelines for those with pediatric training, especially in urban hospitals.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Evidence-Based Medicine
Background:
- Infant wheezing management guidelines are limited.
- Pediatrician treatment practices for first wheezing episodes in infants are not well-documented.
- This study surveyed Spanish pediatricians on their approach to a simulated infant wheezing case.
Purpose of the Study:
- To evaluate current Spanish pediatrician management of a first acute wheezing episode in infants.
- To identify factors influencing treatment decisions for infant wheezing.
- To compare current practices with established asthma guidelines.
Main Methods:
- A survey was distributed to 3000 Spanish pediatricians and child-focused physicians.
- A simulated case of a 5-month-old boy with a mild-to-moderate first wheezing attack was presented.
- Respondents reported their intended treatment, follow-up, and maintenance therapy, along with their professional background.
Main Results:
- Over 90% of 2347 respondents would use a short-acting beta2 agonist (SABA).
- However, only 34.5% would use SABA alone; many added oral or inhaled corticosteroids (ICS).
- Lack of pediatric training and non-urban/rural practice settings were associated with increased ICS use for acute attacks and maintenance therapy.
Conclusions:
- Pediatrician management of first wheezing episodes varies, with frequent addition of corticosteroids.
- Treatment decisions are influenced by physician training and practice setting.
- Adherence to guidelines appears higher among pediatricians with formal training and those in urban hospital settings.
Background:
Although the treatment of asthma has been addressed in several guidelines, the management of the first acute wheezing episode in infants has not often been evaluated. We surveyed practicing pediatricians in Spain about the treatment they would provide in a simulated case.
Material And Methods:
A random sample of 3000 pediatricians and physicians who normally treated children was surveyed. The questionnaire inquired about how they would treat a first mild-to-moderate wheezing attack in a 5-month-old boy with a personal and family history of allergy. Pediatricians were asked about their professional background.
Results:
A total of 2347 questionnaires were returned with useful data (78.2%). Most (90.4%) of the pediatricians would use a short-acting beta2 agonist (SABA) via a metered-dose inhaler with a spacer and a face mask or nebulizer. However, only 34.5% chose a SABA alone: 31.3% added an oral steroid and 27.6% added an inhaled corticosteroid (ICS). The factors associated with the use of ICS in the acute attack were: (1) lack of specific training in pediatrics (OR 1.45; 1.12-1.85) and (2) primary care health center setting (OR 1.31; 1.01-1.69) or rural setting (OR 1.28; 1.01-1.66). Forty-four percent did not recommend any follow-up treatment while 20.7% prescribed ICS as maintenance therapy. The factors related to this decision were the same as those described above.
Conclusions:
The management of a first wheezing episode seems to meet published guidelines among Spanish pediatricians with formal training in pediatrics and in those who work in a hospital setting or in urban areas.
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