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Corticosteroid prescription in children with respiratory symptoms: A real-life study
Remedios Cárdenas Contreras1,2, Alicia Habernau Mena3, Elisa Haroun Díaz4
1Virgen del Rocío University Hospital, Seville, Spain.
Insights
Many children with asthma overuse oral corticosteroids for exacerbations instead of inhaled corticosteroids. This leads to frequent emergency visits and impacts quality of life, highlighting a need for better asthma management strategies.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Asthma is a prevalent childhood illness, with most children responding to standard treatments.
- A subset of pediatric asthma patients remains symptomatic despite initial therapies, necessitating advanced management.
- Current exacerbation management often relies on short-acting beta-agonists and oral corticosteroids, frequently omitting essential maintenance therapies like inhaled corticosteroids.
Purpose of the Study:
- To investigate the utilization of systemic corticosteroids (SC) for respiratory exacerbations in children under 12 years old.
- To assess the gap in maintenance therapy prescription, specifically inhaled corticosteroids (ICS) and anti-leukotrienes, prior to initial pediatric allergy consultation.
Main Methods:
- A descriptive, retrospective, observational, multicenter study.
- Data collected from 144 children under 12 years old attending their first pediatric allergy consultation.
- Analysis focused on systemic corticosteroid use and prescribed maintenance therapies in the year preceding the consultation.
Main Results:
- 70% of children experienced perennial asthma symptoms but were only prescribed SABA on demand, lacking ICS or anti-leukotrienes.
- Children averaged three emergency room visits annually for exacerbations.
- Nearly 75% received systemic corticosteroids (prednisolone) during exacerbations, with over half receiving an average of 2.6 annual cycles, often prescribed in the ER.
Conclusions:
- Significant overuse of systemic corticosteroids was observed in atopic children with respiratory symptoms.
- Inadequate maintenance therapy, particularly the absence of ICS, contributes to frequent exacerbations and SC overuse.
- A shift in clinical practice towards consistent ICS use is crucial for preventing exacerbations and improving quality of life in pediatric asthma patients.
Abstract:
Asthma is one of the most common childhood diseases. Most children respond to low doses of corticosteroids and/or anti-leukotrienes. However, a small percentage remain symptomatic. They require high doses of inhaled corticosteroids (ICS) and anti-leukotrienes, sometimes with long-acting bronchodilators (LABA) and occasionally systemic corticosteroids (SC). However, we frequently observe that the only treatment they receive for exacerbations is short-acting beta-agonists (SABA) and oral corticosteroids (OC) without adding ICS as a maintenance treatment to prevent new episodes. This leads to frequent exacerbations, airflow limitation, and significant alterations in the quality of life. In addition, this results in high resource consumption, frequent emergency room visits, and school absenteeism, leading to absence from work for caregivers. A descriptive, retrospective, observational, and multicenter study was carried out on patients under 12 years of age, who attended pediatric allergy consultations for the first time. The main objective was to determine the consumption of SCs because of respiratory exacerbations in the year before the first consultation. Data were obtained from 144 children, 58.3% male, with a median age of 5 years. It was found that during the year before attending our clinic, 70% had perennial symptoms and were only prescribed with salbutamol on demand when they presented with respiratory symptoms. They had not been prescribed with ICS or anti-leukotrienes. They required attention in the emergency room of their nearest health center or hospital on an average of three times per year. During these exacerbations, almost 75% received SCs(prednisolone), with an average of 2.6 annual cycles (0-12) prescribed in more than half of the cases in the emergency room. In over 80% of the cases, the effects of SC abuse were not previously monitored. The overuse of SC in atopic children with respiratory symptoms was confirmed in our group, which requires considering behavioral changes.
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