Pre-school wheeze treatment patterns in the primary care setting in Italy

Wheeze is one of the most common respiratory conditions in early childhood. Despite available guidelines, treatment management in pre-school children remains challenging. We aim to describe prescribing patterns for pre-schoolers with wheeze in primary care settings. This retrospective population-based birth cohort study analyzed data from the Italian Pedianet primary care database. Children born between 2010 and 2017 and followed from birth to at least 5 years were included. Wheeze episodes were identified through ICD-9-CM codes and validated free-text searches in outpatient records. Prescribing patterns across successive episodes were analyzed using State Sequence Analysis (SSA), overall and stratified by age at first episode, to describe treatment trajectories in primary care from 2010 to 2023. Among 66,981 eligible children, 24.28% experienced at least one wheeze episode. Treatment was provided in 64.96% of episodes, with a median of two treated episodes per child. Initial prescribing showed considerable variation: inhaled beta2-agonists, oral corticosteroids, and inhaled corticosteroids were most commonly used, either alone or combined. Prescribing patterns varied by age, with greater use of inhaled therapies in older children. SSA showed declining numbers of children receiving subsequent treatments and a progressive consolidation toward a limited number of therapeutic regimens over successive episodes. In this primary care cohort, prescribing for pre-school wheeze was heterogeneous and influenced by age at first diagnosis. These findings highlight gaps between real-world practice and current guidelines, emphasizing the need for clearer guidance and targeted implementation strategies for managing wheeze in early childhood.