Children's asthma and the third world: an approach

More than a million visits/year characterize acute asthma morbidity at Venezuela's (24 million inhabitants) Ministry of Health ambulatory services, caring for 80% or more of the population; acute morbidity from asthma is second to "viral syndrome" but ahead of diarrhea and other diseases. These acute episodes are the only contact of a poor asthmatic child with this health care system and portray the prevailing approach focused around acute care: to be reversed, a simple cost/effective program ought to be implemented during these acute asthma visits. Since convenience of administration is a key factor in compliance, a pilot study to explore the efficacy of budesonide CFC 400 microg administered on a once-a-day basis for adherence was carried out within a naturalistic real-world design.

Thirty persistent asthmatic patients attending the Allergology Unit of the Hospital Pediátrico San Juan de Dios in Caracas were enrolled, and their asthma signs/symptoms quantified and registered on diary cards (0-3 scale) as well as peak flow measurements in am/pm for a period of 2 weeks prior to budesonide administration (control data) and until completion of study. Only 12 (mean age: 9 years) of the initial patients were able to properly keep a diary and scheduled visits for a period of 15 weeks.

Data allowed comparison between pre- and post-treatment symptoms/signs scores and PF values. After 3 weeks treatment with budesonide, statistically significant improvements were shown for all parameters, except for PF, whose minor improvements did not reach statistical significance.

Budesonide CFC 400 microg administered once a day seems effective in control of asthma signs/symptoms within study design. Confirmation of the above findings in larger groups of patients, treated similarly and for longer periods of time, seems justified. A simple cost-effective intervention, analogous conceptually to the proven successful oral rehydration therapies for diarrhea in public health, should be considered in third world countries with high urban asthma prevalence.