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Review of prescribed treatment for children with asthma in 1990
1Department of Child Health, University of Southampton, Southampton General Hospital.
Insights
Asthma treatment in children saw increased inhaled steroid use and decreased sodium cromoglycate prescriptions following new guidelines. However, many children on prophylactic treatment still used short-acting inhaled beta-agonists frequently.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pharmacy
Background:
- Asthma management guidelines were published in Great Britain.
- The study aimed to evaluate the impact of these guidelines on pediatric asthma treatment.
Purpose of the Study:
- To review asthma treatments prescribed to children in Great Britain.
- To assess the effectiveness of prophylactic asthma treatment post-guideline publication.
Main Methods:
- A review of prescribing data from January 1990 to June 1991.
- Data collected from a representative sample of general practices using a computer system.
- Included 17,846 children aged 4-17 years with asthma.
Main Results:
- 52.5% of children received preventive treatments; 90.8% received bronchodilators.
- Sodium cromoglycate prescriptions decreased significantly, while inhaled steroid prescriptions increased.
- Only 14.5% of children on prophylactic treatment appeared to use it regularly, with frequent short-acting inhaled beta-agonist use.
Conclusions:
- The study provides baseline data for auditing the impact of clinical guidelines.
- Findings highlight the need to improve adherence to prophylactic treatments.
- There is a particular focus on reducing the reliance on short-acting inhaled beta-agonists in conjunction with prophylactic therapy.
Objective:
To review treatment prescribed to asthmatic children in Great Britain during the 12 months after publication of the first guidelines and to assess effectiveness of prophylactic treatment.
Design:
Review of prescribing information from January 1990 to June 1991 in a representative sample of general practices in Great Britain with a Compufile/AAH Meditel computer.
Subjects:
17,846 children with asthma aged 4-17 years.
Main Outcome Measures:
Numbers of children prescribed different asthma treatments; estimated use of inhaled beta agonists in those receiving prophylactic treatment.
Results:
From January to December 1990, 9,362 (52.5%) children were prescribed preventive treatments. 16,211 (90.8%) children were prescribed bronchodilators of some kind. 3,055 (17.1%) were prescribed sodium cromoglycate, and the proportion decreased significantly during the study (from 19.5% (95% confidence interval 18.6% to 20.4%) to 17.2% (16.4% to 18.1%), P < 0.001, in children aged 4-11 years and from 14.9% (14.0% to 15.9%) to 11.3% (10.4% to 12.2%), P < 0.001, in those aged 12-17 during January-July 1991). 6,952 (39.0%) were prescribed inhaled steroids, and the proportion increased during the study (from 35.1% (34.0% to 36.2%) to 44.1% (43.0% to 45.2%), P < 0.001, in children aged 4-11 years and from 38.7% (37.4% to 40.0%) to 44.1% (42.7% to 45.5%), P < 0.001, in those aged 12-17 during January-July 1991). Only 1,358 of the 9,362 children (14.5%) received sufficient repeat prescriptions to suggest that they might be taking the prophylactic treatment regularly. Among these children short acting inhaled beta agonists were being used on average four to eight times a day.
Conclusions:
These results are useful baseline data for audit of the impact of published clinical guidelines, particularly in terms of reducing the need for short acting inhaled beta agonists with prophylactic treatment.