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Variations in the treatment of childhood asthma
1Sydney University Department of Paediatrics and Child Health, Children's Hospital, Camperdown, NSW.
Insights
Pediatricians, GPs, and respiratory physicians generally agree on childhood asthma management but deviate from guidelines. Key areas for improvement include oxygen use, oral vs. inhaled medications, and prophylaxis strategies for better asthma control.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Practice Guidelines
Background:
- Childhood asthma requires consistent management strategies aligned with evidence-based guidelines.
- Variations in clinical practice can impact the effectiveness of asthma treatment in children.
Purpose of the Study:
- To survey current practices in childhood asthma assessment and management among various medical specialists.
- To compare these practices against the Australian and New Zealand Consensus Statement guidelines.
Main Methods:
- A postal questionnaire was distributed to a random sample of 100 paediatricians, 300 general practitioners, and 100 respiratory physicians.
- The questionnaire covered asthma assessment, acute and mild asthma management, prophylaxis, and medication delivery methods.
Main Results:
- Response rates varied by specialty (Paediatricians 88%, GPs 66%, Respiratory Physicians 51%).
- General agreement on asthma management was observed, but significant deviations from guidelines were noted, including suboptimal use of oxygen, oral beta-2 agonists, and aminophylline.
- Underutilization of spacer devices and differing preferences for prophylactic medications were also identified.
Conclusions:
- There is a need for enhanced education on oxygen and oral corticosteroid use in acute asthma.
- Reducing reliance on intravenous aminophylline and increasing the use of spacer devices are recommended.
- Greater emphasis on sodium cromoglycate for daily prophylaxis in children is advised.
Objective:
To survey the assessment and management of childhood asthma by paediatricians, general practitioners, and respiratory physicians, and compare these findings with the Australian and New Zealand Consensus Statement guidelines on asthma management in children.
Setting And Design:
A six-item postal questionnaire designed to cover assessment, management of acute and mild asthma, use of prophylaxis and methods of delivery of medication.
Participants:
A random sample of 100 paediatricians, 300 general practitioners and 100 respiratory physicians.
Results:
Response rates were: paediatricians, 88%; general practitioners, 66%; and respiratory physicians 51%. There was agreement between all three groups in most aspects of asthma management. Deviations from the Consensus Statement guidelines included: between 38% and 49% not using oxygen as one of the first-line treatments for acute asthma; a higher use of orally administered beta 2-agonists by general practitioners (up to 40% for children between one and three years compared with 17% of paediatricians and 12% of respiratory physicians); a tendency to use intravenously administered aminophylline before corticosteroids (20% of paediatricians, 40% of general practitioners and 30% of respiratory physicians); a preference among general practitioners and respiratory physicians to prescribe inhaled corticosteroids rather than sodium cromoglycate for prophylaxis in older children; and a low incidence of use of spacer devices in older children.
Conclusions:
If currently published recommendations on managing asthma in children are followed, there should be: more education and emphasis on the value of oxygen and short courses of orally administered corticosteroids in acute asthma management; less reliance on intravenously administered aminophylline; decreased use of orally administered beta 2-agonists coupled with a more wide-spread use of spacer devices; and an increased emphasis on sodium cromoglycate as first-line daily prophylaxis.