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Published on: May 10, 2024
The therapy of pre-school wheeze: appropriate and fair?
E S Chauliac1, M Silverman, M Zwahlen
1Department of Social and Preventive Medicine, Swiss Paediatric Respiratory Research Group, University of Bern, Bern, Switzerland.
Insights
Prevalence of asthma medication use in UK preschoolers shows under-treatment of severe wheeze and over-treatment of mild cases. Inhaled corticosteroid (ICS) use varied by wheeze severity and phenotype, with disparities in South Asian children and girls.
Area of Science:
- Pediatric Pulmonology
- Community Health
- Pharmacotherapy
Background:
- Wheeze is a common respiratory symptom in preschool children, often leading to asthma medication use.
- Understanding the prevalence and patterns of asthma medication use in this age group is crucial for appropriate management.
- Current guidelines recommend specific treatments based on wheeze severity and phenotype, but real-world adherence is not well-documented.
Purpose of the Study:
- To determine the prevalence and distribution of asthma medication use for wheeze in a UK preschool population.
- To investigate the relationship between medication use (bronchodilators, inhaled corticosteroids (ICS), oral corticosteroids) and wheeze characteristics.
- To identify potential disparities in treatment based on ethnicity, sex, and wheeze phenotype.
Main Methods:
- A postal questionnaire was administered to parents of 4,277 randomly selected UK children aged 1-5 years.
- A total of 3,410 participants completed the survey, with deliberate over-representation of children of South Asian descent.
- Data collected included reported use of bronchodilators, ICS, and oral corticosteroids in the past 12 months, along with wheeze frequency, severity, and phenotype.
Main Results:
- During the previous 12 months, 18% of children received bronchodilators, 8% ICS, and 3% oral corticosteroids. Among current wheezers, these figures were 55%, 25%, and 12%, respectively.
- ICS use increased with wheeze severity but did not exceed 60% even in the most severe category. Conversely, 42% of children on ICS reported infrequent recent wheeze.
- ICS use was lower in children with episodic viral wheeze (17%) compared to multiple-trigger wheezers (40%). Treatment was less common in South Asian children and girls, indicating potential undertreatment of severe cases and overtreatment of milder conditions.
Conclusions:
- While a significant proportion of preschool children use asthma inhalers, treatment appears inadequately tailored to wheeze severity and phenotype.
- There is evidence of undertreatment of severe wheeze with ICS, particularly in girls and South Asian children.
- Conversely, there may be overtreatment of mild wheeze, episodic viral wheeze, and chronic cough with ICS.
Abstract:
The current study aimed to assess prevalence and distribution of use of asthma medication for wheeze in pre-school children in the community. We sent a postal questionnaire to the parents of a random population-based sample of 4,277 UK children aged 1-5 years; 3,410 participated (children of south Asian decent were deliberately over-represented). During the previous 12 months, 18% of the children were reported to have received bronchodilators, 8% inhaled corticosteroids (ICS) and 3% oral corticosteroids. Among current wheezers these proportions were 55%, 25%, and 12%, respectively. Use of ICS increased with reported severity of wheeze, but did not reach 60% even in the most severe category. In contrast, 42% of children receiving ICS reported no or very infrequent recent wheeze. Among children with the episodic viral wheeze phenotype, 17% received ICS compared with 40% among multiple-trigger wheezers. Use of ICS by current wheezers was less common in children of South Asian ethnicity and in girls. Although a high proportion of pre-school children in the community used asthma inhalers, treatment seemed to be insufficiently adjusted to severity or phenotype of wheeze, with relative under-treatment of severe wheeze with ICS, especially in girls and South Asian children, but apparent over-treatment of mild and episodic viral wheeze and chronic cough.
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