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Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals
Dong In Suh1, Hyeon Jong Yang2, Bong Seong Kim3
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Insights
Korean children show unique asthma patterns, with less severe cases and a preference for leukotriene receptor antagonists (LTRA) over inhaled corticosteroids (ICS) in young children. Management strategies need regional tailoring.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Asthma guidelines often lack regional specificity.
- Understanding local asthma profiles is crucial for effective management.
- Korean children's asthma characteristics require distinct evaluation.
Purpose of the Study:
- To delineate the specific asthma severity profile in Korean children.
- To analyze controller medication prescription patterns in this population.
- To compare these findings with Western and Asia-Pacific guidelines.
Main Methods:
- Review of 840 asthmatic children's medical records by 12 pediatric allergists.
- Classification of controller prescriptions into four categories.
- Assessment of asthma severity using Global Initiative for Asthma (GINA) and Japanese Pediatric GuideLine (JPGL) criteria.
Main Results:
- Prevalence of intermittent asthma was 39.0% (GINA) and 29.6% (JPGL).
- Severe persistent asthma was observed in 2.9% (GINA) and 2.5% (JPGL).
- Leukotriene receptor antagonists (LTRA) were frequently used, especially in children under 6 years.
Conclusions:
- Korean children exhibit a lower prevalence of severe asthma compared to Western data.
- A preference for LTRA over low-dose inhaled corticosteroids (ICS) or long-acting beta-agonists (LABA) was noted in asthmatics <6 years.
- Development of region-specific asthma management strategies is recommended.
Purpose:
Guidelines need to be tailored to where they are applied. We aimed to describe the distinctive asthma severity profile and the pattern of controller prescription in Korean children.
Methods:
Twelve pediatric allergists from tertiary medical centers reviewed medical records of all asthmatic children who visited their clinics between September 1 and November 30 of 2013. Controller prescriptions were re-classified into 4 categories, then the prevalence of each asthma severity category and the controller prescription patterns according to asthma severity assessed by a Western (Global Initiative for Asthma, GINA) and an Asia-Pacific (Japanese Pediatric GuideLine, JPGL) guideline were evaluated.
Results:
A total of 840 cases were reviewed. Both GINA and JPGL revealed that 328 (39.0%) and 249 (29.6%) subjects had intermittent asthma whereas 24 (2.9%) and 21 (2.5%) subjects had severe persistent asthma, respectively. Although higher category controllers tended to be prescribed to those who had more severe asthma, there was much overlap in categories of prescribed controllers between groups with regard to asthma severities. Leukotriene receptor antagonists (LTRA) was the most frequently prescribed as a single controller (40%) or as an add-on medication (19%) in the group of asthmatic children <6 years.
Conclusions:
Korean children have distinctive patterns of asthma severity and management strategies with a lower prevalence of severe asthma and a preference toward LTRA rather than low dose inhaled corticosteroids (ICS) alone or add-on long-acting beta-agonist (LABA) in the group of <6 year-old asthmatics that has not been predicted in Western countries. Thus, strategies tailored to regional situations need to be developed and recommended.
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