Skip to main content
SpringerLink
Log in

The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

We evaluated the adherence to national guidelines for the treatment of asthma in childhood.

Methods

Prescriptions for anti-asthma medication for children (0–14 years of age) were retrieved from the InterAction DataBase (IABD) for the year 2002. These were compared with recommendations found in national guidelines.

Results

Anti-asthma medication was prescribed for 3,612 children (5%) of the paediatric population. Inhaled medication was prescribed for 3,554 (98%) children. In 1,940 of 1,993 (97%) of the children under the age of 6 years pressurised metered dose inhalers (pMDIs) were given. Short-acting β2-agonists had not been prescribed in the previous 2-year period in 559 children (15%), 543 children older than 8 years (36%) did not receive a prescription for a dry powder inhalator and 239 children (7%) had more than one type of inhalator. Long-acting β2-agonists were prescribed in 396 children, but without concomitant inhaled corticosteroids (ICS) in 35 children (9%).

Conclusions

Inhalation therapy as the method of choice in asthma therapy and the use of pMDI in preschool children are widely accepted in the Netherlands. Not all children have been prescribed bronchodilators. Some children have more than one type of inhaler device and others use long-acting β2-agonists not in combination with ICS. Although national and international guidelines about the treatment of asthma in children offer evidence-based advice, important principles are not followed. Effective interventions aimed at implementing existing guidelines into daily practice are urgently needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

IADB:

InterAction DataBase

pMDI:

Pressurised metered dose inhalator

DPI:

Dry powder inhalator

SABA:

Short-acting β2-agonist

LABA:

Long-acting β2-agonist

OTC:

Over-the-counter

LTRA:

Leucotriene receptor antagonist

ATC:

Anatomical Therapeutic Chemical classification of drugs

References

  1. Altman DG, Machin D, Bryant TN, Gardner MJ (2000) Statistics with confidence. BMJ Books

  2. Anonymous (1997) Asthma in adults and schoolchildren. The General Practitioner in Asthma Group, the British Association of Accident and Emergency Medicine, The British Paediatric Respiratory Society and the Royal College of Paediatrics and Child Health. Thorax 52(suppl 1):s2–s8

    Google Scholar 

  3. Anonymous (1997) Asthma in children under five years of age. The General Practitioner in Asthma Group, the British Association of Accident and Emergency Medicine, The British Paediatric Respiratory Society and the Royal College of Paediatrics and Child Health. Thorax 52(suppl 1):s9–s20

    Google Scholar 

  4. Anonymous (2004) ATC classification index with DDDs. WHO Collaborating Centre for Drug Statistics Methodology, Oslo, January

    Google Scholar 

  5. de Baets F, van Daele S, Franckx H, Vinaimont F (1998) Inhaled steroids compared with disodium cromoglycate in preschool children with episodic viral wheeze. Pediatr Pulmonol 25:361–366

    Article  PubMed  Google Scholar 

  6. Beimfohr C, Maziak, W, Von Mutius E, Hense HW, Leupold W, Hirsch T, Keil U, Weiland SK (2001) The use of anti-asthmatic drugs in children: results of a community-based survey in Germany. Pharmacoepidemiol Drug Saf 10:315–321

    Article  PubMed  CAS  Google Scholar 

  7. Cabana MD, Rand CS, Becher OJ, Rubin HR (2001) Reasons for pediatrician nonadherence to asthma guidelines. Arch Pediatr Adolesc Med 155:1057–1062

    PubMed  CAS  Google Scholar 

  8. Child F, Davies S, Clayton S, Fryer AA, Lenney W (2002) Inhaler devices for asthma: do we follow the guidelines? Arch Dis Child 86:176–179

    Article  PubMed  CAS  Google Scholar 

  9. Dashash NA, Mukhtar SH (2003) Prescribing for asthmatic children in primary care. Are we following guidelines? Saudi Med J 24:507–511

    PubMed  Google Scholar 

  10. Dirksen WJ, Geijer RMM, de Haan M, Koning G, Flikweert S, Kolnaar BGM (1998) Guidelines for the treatment of asthma by general practitioners. Huisarts Wet 41:103–143

    Google Scholar 

  11. Global Initiative for Asthma (GINA) (2002) Global strategy for asthma management and prevention. National Institutes of Health. National Heart, Lung, and Blood Institute. Bethesda, MD

    Google Scholar 

  12. Haby MM, Powell CV, Oberklaid F, Waters EB, Robert CF (2002) Asthma in children: gaps between current management and best practice. J Paediatr Child Health 38:284–289

    Article  PubMed  CAS  Google Scholar 

  13. Hoekstra MO (1997) Medical treatment of asthma in children; revised guidelines by paediatric pulmonologists. Ned Tijdschr Geneeskd 141:2223–2228

    PubMed  CAS  Google Scholar 

  14. de Jong-Van den Berg LTW, Feenstra N, Sorensen HT, Cornel MC (1999) Improvement of drug exposure data in a registration of congenital anomalies. Pilot-study: pharmacist and mother as sources for drug exposure data during pregnancy. EuroMAP Group. European Medicine and Pregnancy Group. Teratology 60:33–36

    Article  PubMed  Google Scholar 

  15. Kamps AW, van Ewijk B, Roorda RJ, Brand PL (2000) Poor inhalation technique, even after inhalation instructions, in children with asthma. Pediatr Pulmonol 29:39–42

    Article  PubMed  CAS  Google Scholar 

  16. Klungel OH, de Boer A, Paes AHP, Herings RMC, Seidell JC, Bakker A (1999) Agreement between self-reported antihypertensive drug use and pharmacy records in a population-based study in the Netherlands. Pharm World Sci 21:218–220

    Article  Google Scholar 

  17. Mutius von E (2003) Epidemiology of allergic diseases. In: Leung DYM, Sampson HA, Geha RS, Szefler SJ (eds) Pediatric allergy, practice and principles. Mosby, St. Louis, pp 1–9

    Google Scholar 

  18. Monster TBM, Janssen WMT, de Jong PE, de Jong-van den Berg LTW (2002) Pharmacoepidemiol Drug Saf 11:379–384

    Article  PubMed  Google Scholar 

  19. Ng Man Kwong G, Proctor A, Billings C, Duggan R, Das C, Whyte MKB, Powell CVE, Primhak R (2001) Increasing prevalence of asthma diagnosis and symptoms in children is confined to mild symptoms. Thorax 56:312–314

    Article  Google Scholar 

  20. Pedersen S (1994) Inspiratory capacity through Turbuhaler in various patient groups. J Aero Med 7:S55S–S58S

    Google Scholar 

  21. Schirm E, Monster TBM, De Vries R, Van den Berg PB, de Jong-van den Berg LTW, Tobi H (2004) How to estimate the population that is covered by community pharmacies? An evaluation of two methods using drug utilisation information. Pharmacoepidemiol Drug Saf 13:173–179

    Article  PubMed  Google Scholar 

  22. Shiffman, RN, Freudigman A, Brandt CA, Liaw Y, Navedo DD (2000) A guideline implementation system using handheld computers for office management of asthma: effects on adherence and patient outcomes. Pediatrics 105:767–773

    Article  PubMed  CAS  Google Scholar 

  23. Smeele IJM, Grol RPTM, Van Schayck CP, Van den Bosch WJHM, Van den Hoogen HJM, Muris JWM (1999) Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease? Qual Health Care 8:92–98

    PubMed  CAS  Google Scholar 

  24. Sookaneknu P, Richards RME, Sanguansermsri J, Teerasut C (2004) Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Ann Pharmacother 38:2023–2028

    Article  Google Scholar 

  25. Strachan DP (1995) Epidemiology. In: Silvermann M (ed) Childhood asthma and other wheezing disorders. Chapman & Hall, London, pp 7–31

    Google Scholar 

  26. Tobi H, van den Berg PB, de Jong-van den Berg LTW (2000) The InterAction database: synergy of science and practice in pharmacy. Lect Notes Comput Sci 1933:206–211

    Article  Google Scholar 

  27. Tobi H, van den Heuvel NJN, de Jong-van den Berg LTW (2004) Does uncollected medication reduce the validity of pharmacy dispensing data? Pharmacoepidemiol Drug Saf 13:497–500

    Article  PubMed  Google Scholar 

  28. Van Schayck CP, Smit HA (2005) The prevalence of asthma in children: a reversing trend. Eur Resp J 26:647–650

    Article  Google Scholar 

  29. Veninga CCM, Lagerlov P, Wahlstroem R, Muskova, Denig P, Berkhof J, Kochen MM, Haaijer-Ruskamp FM (1999) Evaluating an educational intervention to improve the treatment of asthma in four European countries. Am J Respir Crit Care Med 160:1254–1262

    PubMed  CAS  Google Scholar 

  30. Verberne AAPH, Frost C, Roorda RJ, Van der Laag J, Kerrebijn KF, The Dutch Paediatric Asthma Study Group (1997) One year treatment with salmeterol compared with beclomethasone in children with asthma. Am J Respir Crit Care Med 156:688–695

    PubMed  CAS  Google Scholar 

  31. Warner JO (2003) Guidelines for treatment of asthma. In: Leung DYM, Sampson HA, Geha RS, Szefler SJ (eds) Pediatric allergy, practice and principles. Mosby, St. Louis, pp 350–356

    Google Scholar 

Download references

Acknowledgement

We thank Dr. J. Collins for reviewing the English.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Medical Centre Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands

    Tjalling W. de Vries

  2. Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration (GUIDE), Ant. Deusinglaan 1, 9713 AV, Groningen, The Netherlands

    Hilde Tobi, Eric Schirm, Paul van den Berg & Lolkje T. W. de Jong-van den Berg

  3. Paediatric Pulmonology, Beatrix Children Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    Eric J. Duiverman

Authors
  1. Tjalling W. de Vries
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hilde Tobi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Schirm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul van den Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric J. Duiverman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lolkje T. W. de Jong-van den Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tjalling W. de Vries.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Vries, T.W., Tobi, H., Schirm, E. et al. The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands. Eur J Clin Pharmacol 62, 51–55 (2006). https://doi.org/10.1007/s00228-005-0065-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-005-0065-z

Keywords

Search

Navigation