European Journal of Clinical Pharmacology

, Volume 63, Issue 7, pp 693–698 | Cite as

Use of anti-asthmatic medications as a proxy for prevalence of asthma in children and adolescents in Norway:a nationwide prescription database analysis

  • Kari Furu
  • Svetlana Skurtveit
  • Arnulf Langhammer
  • Per Nafstad
Pharmacoepidemiology and Prescription

Abstract

Background and objective

The validity of using self-reported or parental reported asthma symptoms and/or doctor-diagnosed asthma in the estimation of asthma prevalence among children has been questioned. The aim of this study was to assess the prevalence of dispensed anti-asthmatic medications as a proxy of asthma among children and adolescents aged 0–19 years in Norway.

Methods

Prescription data on subjects aged 0–19 years receiving at least one prescription for an anti-asthmatic during 2004 were retrieved from the nationwide Norwegian Prescription Database.

Results

Overall, 108,719 (9.1% of the Norwegian population aged 0–19 years) individuals received at least one prescription for medication(s) for obstructive airway diseases. The application of criteria that restricted the study population to those receiving inhaled anti-asthmatic medications and those receiving medications reimbursed by the Norwegian health care system for asthma resulted in the identification of 64,458 (5.4%) individuals (4.6% of girls and 6.2% of boys). The prevalence varied by age, with a maximum in both genders at about 2 years of age (7.0% of girls and 10.1% of boys) and a minimum in girls at about 10 years of age (3.3%) and in boys at about 19 years of age (3.5%). Anti-asthmatic inhalants were more frequently prescribed among boys than among girls during the first 15 years of life. Of the children treated, 75% received inhaled glucocorticoids (ICS) in combination with β2-agonists, of whom 38% received a fixed combination in one inhaler.

Conclusions

In 2004, about 1 in 20 Norwegians aged 0–19 years were in need of medical treatment for asthma for at least 3 months, reflecting ongoing and clinically important asthma. A rather high proportion of children received fixed combinations of ICS and long-acting β2-agonists, which may indicate moderate to severe asthma.

Keywords

Adolescents Asthma Children Prescription database Prevalence 

References

  1. 1.
    Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC (1998) The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 351:1225–1232CrossRefGoogle Scholar
  2. 2.
    Anderson HR, Ruggles R, Strachan DP, Austin JB, Burr M, Jeffs D, Standring P, Steriu A, Goulding R (2004) Trends in prevalence of symptoms of asthma, hay fever, and eczema in 12–14 year olds in the British Isles, 1995–2002: questionnaire survey. BMJ 328:1052–1053PubMedCrossRefGoogle Scholar
  3. 3.
    Magnus P, Jaakkola JJ (1997) Secular trend in the occurrence of asthma among children and young adults: critical appraisal of repeated cross sectional surveys. BMJ. 314:1795–1799PubMedGoogle Scholar
  4. 4.
    Crane J, Mallol J, Beasley R, Stewart A, Asher MI (2003) Agreement between written and video questions for comparing asthma symptoms in ISAAC. Eur Respir J 21:455–461PubMedGoogle Scholar
  5. 5.
    Smeeton NC, Rona RJ, Oyarzun M, Diaz PV (2006) Agreement between responses to a standardized asthma questionnaire and a questionnaire following a demonstration of asthma symptoms in adults. Am J Epidemiol 163:384–391PubMedCrossRefGoogle Scholar
  6. 6.
    Osborne ML, Vollmer WM, Johnson RE, Buist AS (1995) Use of an automated prescription database to identify individuals with asthma. J Clin Epidemiol 48:1393–1397PubMedCrossRefGoogle Scholar
  7. 7.
    Kozyrskyj AL, Mustard CA, Becker AB (2004) Identifying children with persistent asthma from health care administrative records. Can Respir J 11:141–145PubMedGoogle Scholar
  8. 8.
    Lynd LD, Guh DP, Pare PD, Anis AH (2002) Patterns of inhaled asthma medication use: a 3-year longitudinal analysis of prescription claims data from British Columbia, Canada. Chest 122:1973–1981PubMedCrossRefGoogle Scholar
  9. 9.
    de Vries TW, Tobi H, Schirm E, van den Berg P, Duiverman EJ, de Jong-van den Berg LT (2006) 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. 62:51–55PubMedCrossRefGoogle Scholar
  10. 10.
    Furu K (2001) Drug utilisation in a public health perspective: Establishing a national prescription register in Norway. Norwegian J Epidemiol 11:55–60Google Scholar
  11. 11.
    WHO Collaborating Centre for Drug Statistics Methodology (2005) Guidelines for ATC classification and DDD assignment. Norwegian Institute of Public Health, Oslo, NorwayGoogle Scholar
  12. 12.
    Haga A, Sverre JM (2002) Pricing and reimbursement of pharmaceuticals in Norway. Eur J Health Econ 3:215–220PubMedCrossRefGoogle Scholar
  13. 13.
    Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. NIH Publication No. 02–3659 Issued January, 1995 (updated 2002). Management Segment (Chapter 7): updated 2005 from the 2004 document. Available at: http://www.ginasthma.com
  14. 14.
    Wogelius P, Poulsen S, Sorensen HT (2005) Validity of parental-reported questionnaire data on Danish children’s use of asthma-drugs: a comparison with a population-based prescription database. Eur J Epidemiol 20:17–22PubMedCrossRefGoogle Scholar
  15. 15.
    von Hertzen L, Haahtela T (2005) Signs of reversing trends in prevalence of asthma. Allergy 60:283–292CrossRefGoogle Scholar
  16. 16.
    Naureckas ET, Dukic V, Bao X, Rathouz P (2005) Short-acting beta-agonist prescription fills as a marker for asthma morbidity. Chest 128:602–608PubMedCrossRefGoogle Scholar
  17. 17.
    Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM (1993) Primary non-compliance with prescribed medication in primary care. BMJ 307:846–848PubMedCrossRefGoogle Scholar
  18. 18.
    OECD Health Data (2005) A comparative analysis of 30 countries: 2005 edition OECD (Organisation for Economic Co-operation and Development). ISBN 9264008764Google Scholar
  19. 19.
    Pont LG, van der Werf GT, Denig P, Haaijer-Ruskamp FM (2002) Identifying general practice patients diagnosed with asthma and their exacerbation episodes from prescribing data. Eur J Clin Pharmacol 57:819–825PubMedCrossRefGoogle Scholar
  20. 20.
    Selnes A, Nystad W, Bolle R, Lund E (2005) Diverging prevalence trends of atopic disorders in Norwegian children. Results from three cross-sectional studies. Allergy 60:894–899PubMedCrossRefGoogle Scholar
  21. 21.
    Tollefsen E, Bjermer L, Langhammer A, Johnsen R, Holmen TL (2006) Adolescent respiratory symptoms-girls are at risk: the Young-HUNT study, Norway. Respir Med 100:471–476PubMedCrossRefGoogle Scholar
  22. 22.
    Carlsen KCL, Haland G, Devulapalli CS, Munthe-Kaas M, Pettersen M, Granum B, Lovik M, Carlsen KH (2006) Asthma in every fifth child in Oslo, Norway: a 10-year follow up of a birth cohort study. Allergy 61:454–460PubMedCrossRefGoogle Scholar
  23. 23.
    Roberts EM (2003) Does your child have asthma? Parent reports and medication use for pediatric asthma. Arch Pediatr Adolesc Med. 157:449–455PubMedCrossRefGoogle Scholar
  24. 24.
    Nafstad P, Magnus P, Jaakkola JJ (2000) Early respiratory infections and childhood asthma. Pediatrics 106:e38PubMedCrossRefGoogle Scholar
  25. 25.
    Nafstad P, Brunekreef B, Skrondal A, Nystad W (2005) Early respiratory infections, asthma, and allergy: 10-year follow-up of the Oslo Birth Cohort. Pediatrics 116:e255–e262PubMedCrossRefGoogle Scholar
  26. 26.
    Osman M (2003) Therapeutic implications of sex differences in asthma and atopy. Arch Dis Child 88:587–590PubMedCrossRefGoogle Scholar
  27. 27.
    Wright AL, Stern DA, Kauffmann F, Martinez FD (2006) Factors influencing gender differences in the diagnosis and treatment of asthma in childhood: The Tucson Children’s Respiratory Study. Pediatr Pulmonol 41:318–325PubMedCrossRefGoogle Scholar
  28. 28.
    Stein RT, Martinez FD (2004) Asthma phenotypes in childhood: lessons from an epidemiological approach. Paediatr Respir Rev 5:155–161PubMedCrossRefGoogle Scholar
  29. 29.
    Venn A, Lewis S, Cooper M, Hill J, Britton J (1998) Questionnaire study of effect of sex and age on the prevalence of wheeze and asthma in adolescence. BMJ 316:1945–1946PubMedGoogle Scholar
  30. 30.
    Pekkanen J, Pearce N (1999) Defining asthma in epidemiological studies. Eur Respir J 14:951–957PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Kari Furu
    • 1
  • Svetlana Skurtveit
    • 1
  • Arnulf Langhammer
    • 2
  • Per Nafstad
    • 3
    • 4
  1. 1.Department of Pharmacoepidemiology, Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway
  2. 2.HUNT Research Centre, Department of Public Health and General Practice, Faculty of MedicineNorwegian University of Science and TechnologyVerdalNorway
  3. 3.Institute of General Practice and Community Medicine, Medical FacultyUniversity of OsloOsloNorway
  4. 4.Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway

Personalised recommendations