Skip to main content

Advertisement

SpringerLink
Log in

Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000–2009 period

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

Abstract

Objective

The objective of this study was to analyse inter-and intra-country quantitative and qualitative differences in anti-asthmatic prescriptions to children and adolescents.

Methods

A literature search was performed in EMBASE and MEDLINE to identify pharmaco-epidemiological studies published from January 1, 2000 to December 31, 2008 in which anti-asthmatic prescription prevalence in out-hospital children was measured. A meta-analytic weighted average and 95% confidence intervals of prescription prevalences were calculated using a random-effect(s) model. Inter- and intra-country quantitative and, where possible, qualitative prescribing patterns were compared and assessed.

Results

Twelve studies were identified (ten from Europe, one from Canada and one from the USA), but epidemiological indicators varied widely, and only eight were suitable for meta-analysis. The data from these studies revealed inter-country quantitative differences in prescription prevalences in the overall population ≤19 years, with Italy having a prescription prevalence of 19.0%, Canada, 18.0%, USA, 14.6%, Denmark, 13.9%, Norway, 9.1% and the Netherlands, 6.2%. The overall prevalence was 13.3%. The analysis of qualitative inter-country differences revealed that, except for Italy, inhalatory short-acting β-agonists were the most prescribed, followed by inhalatory corticosteroids.

Conclusions

This first overall analysis of anti-asthmatic utilization studies in out-of-hospital children indicates a wide variability in anti-asthmatic prescription prevalence. It also reveals that epidemiological evaluations should be improved by using homogeneous indicators and, in order to validate the use of anti-asthmatic prescription as a proxy of disease, the diagnosis of asthma should accompany the data of prescriptions within the same population.

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

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ICS:

Inhaled corticosteroid

LABA:

Long-acting β-agonist

LTRA:

Leukotriene receptor antagonist

SABA:

Short-acting β-agonist

URTI:

Upper respiratory tract infection

References

  1. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, Williams H (2006) Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 368:733–743

    Article  PubMed  Google Scholar 

  2. WHO Global Burden Disease (2004) Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed 10 June 2009

  3. Guidelines for the Diagnosis and Management of Asthma (EPR-3) (2007) Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf Accessed 25 June 2009

  4. British Guideline on the Management of Asthma BTS/SIGN (2008). Available at: http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/sign101%20revised%20June%2009.pdf Accessed 25 July 2009

  5. Global Strategy for Asthma Management and Prevention (2008) Available at: http://www.ginasthma.com/GuidelinesResources.asp?l1=2&l2=0 Accessed 15 Jan 2010

  6. Cloutier MM, Wakefield DB, Sangeloty-Higgins P, Delaronde S, Hall CB (2006) Asthma guideline use by pediatricians in private practice and asthma morbidity. Pediatrics 118:1880–1887

    Article  PubMed  Google Scholar 

  7. Maziak W, von Mutius E, Beimfohr C, Hirsch T, Leupold W, Keil U, Weiland SK (2002) The management of childhood asthma in the community. Eur Respir J 20:1476–1482

    Article  CAS  PubMed  Google Scholar 

  8. Clavenna A, Rossi E, Berti A, Pedrazzi G, De RM, Bonati M (2003) Inappropriate use of anti-asthmatic drugs in the Italian paediatric population. Eur J Clin Pharmacol 59:565–569

    Article  PubMed  Google Scholar 

  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 62:51–55

    Google Scholar 

  10. Furu K, Skurtveit S, Langhammer A, Nafstad P (2007) Use of anti-asthmatic medications as a proxy for prevalence of asthma in children and adolescents in Norway: a nationwide prescription database analysis. Eur J Clin Pharmacol 63:693–698

    Article  CAS  PubMed  Google Scholar 

  11. Smith LA, Bokhour B, Hohman KH, Miroshnik I, Kleinman KP, Cohn E, Cortés DE, Galbraith A, Rand C, Lieu TA (2008) Modifiable risk factors for suboptimal control and controller medication underuse among children with asthma. Pediatrics 122:760–769

    Article  PubMed  Google Scholar 

  12. Stempel DA, McLaughin TP, Stanford RH, Fuhlbrigge AL (2005) Patterns of asthma control: a 3-year analysis of patient claims. J Allergy Clin Immunol 115:935–939

    Article  PubMed  Google Scholar 

  13. Scholtens S, Wijga AH, Seidell JC, Brunekreef B, de Jongste JC, Gehring U, Postma DS, Kerkhof M, Smit HA (2009) Overweight and changes in weight status during childhood in relation to asthma symptoms at 8 years of age. J Allergy Clin Immunol 123:1312–1318

    Article  PubMed  Google Scholar 

  14. Thomsen SF, Ulrik CS, Larsen K, Backer V (2004) Change in prevalence of asthma in Danish children and adolescents. Ann Allergy Asthma Immunol 92:506–511

    Article  PubMed  Google Scholar 

  15. Selnes A, Odland JO, Bolle R, Holt J, Dotterud LK, Lund E (2001) Asthma and allergy in Russian and Norwegian schoolchildren: results from two questionnaire-based studies in the Kola Peninsula, Russia, and northern Norway. Allergy 56:344–348

    Article  CAS  PubMed  Google Scholar 

  16. Impicciatore P, Choonara I, Clarkson A, Provasi D, Pandolfini C, Bonati M (2001) Incidence of adverse drug reactions in paediatric in/out-patients: a systematic review and meta-analysis of prospective studies. Br J Clin Pharmacol 52:77–83

    Article  CAS  PubMed  Google Scholar 

  17. Berkey CS, Hoaglin DC, Mosteller F, Colditz GA (1995) A random-effects regression model for meta-analysis. Stat Med 14:395–411

    Article  CAS  PubMed  Google Scholar 

  18. Kozyrskyj AL, Mustard CA, Becker AB (2004) Identifying children with persistent asthma from health care administrative records. Can Respir J11:141–5.

    Google Scholar 

  19. Vegni FE, Wilkinson P (2006)Patterns of respiratory drug use in the Lombardy region of Italy, 1995–1997. Eur J Epidemiol 21:537–44.

    Google Scholar 

  20. Wang LY, Zhong Y, Wheeler L (2006) Asthma medication use in school-aged children. J Asthma 43:495–499

    Article  PubMed  Google Scholar 

  21. Bianchi M, Clavenna A, Labate L, Bortolotti A, Fortino I, Merlino L, Locatelli GW, Giuliani G, Bonati M (2009) Anti-asthmatic drug prescriptions to an Italian paedriatic population. Pediatr Allergy Immunol 20:585–591

    Article  PubMed  Google Scholar 

  22. Cazzato T, Pandolfini C, Campi R, Bonati M (2001) Drug prescribing in out-patient children in Southern Italy. Eur J Clin Pharmacol 57:611–616

    Article  CAS  PubMed  Google Scholar 

  23. Clavenna A, Berti A, Gualandi L, Rossi E, De RM, Bonati M (2009) Drug utilisation profile in the Italian paediatric population. Eur J Pediatr 168:173–180

    Article  PubMed  Google Scholar 

  24. Furu K, Skurtveit S, Rosvold EO (2005) Self-reported medical drug use among 15–16 year-old adolescents in Norway. Tidsskr Nor Laegeforen 125:2759–2761

    PubMed  Google Scholar 

  25. Ingvardsen BK, Kampmann JM, Laursen LC, Johansen HL (2000) Utilization of anti-asthmatic drugs among Danish children in 1998. Ugeskr Laeger 162:6062–6065

    CAS  PubMed  Google Scholar 

  26. Khaled LA, Ahmad F, Brogan T, Fearnley J, Graham J, MacLeod S, McCormick J (2003) Prescription medicine use by one million Canadian children. Pediatr Child Health 8[Suppl A]:6A–56A

  27. Korelitz JJ, Zito JM, Gavin NI, Masters MN, McNally D, Irwin DE, Kelleher K, Bethel J, Xu Y, Rubin J, Mattison DR (2008) Asthma-related medication use among children in the United States. Ann Allergy Asthma Immunol 100:222–229

    Article  PubMed  Google Scholar 

  28. Moth G, Vedsted P, Schiotz P (2007) Identification of asthmatic children using prescription data and diagnosis. Eur J Clin Pharmacol 63:605–611

    Article  PubMed  Google Scholar 

  29. Schirm E, Tobi H, Gebben H, de Jong-van den Berg LT (2002) Anti-asthmatic drugs and dosage forms in children: a cross-sectional study. Pharm World Sci 24:162–165

    Article  CAS  PubMed  Google Scholar 

  30. Zuidgeest MG, van Dijk L, Smit HA, van der Wouden JC, Brunekreef B, Leufkens HG, Bracke M (2008) Prescription of respiratory medication without an asthma diagnosis in children: a population based study. BMC Health Serv Res 8:16

    Article  PubMed  Google Scholar 

  31. Clavenna A, Bonati M (2009) Drug prescriptions to outpatient children: a review of the literature. Eur J Clin Pharmacol 65:749

    Article  PubMed  Google Scholar 

  32. Masoli M, Fabian D, Holt S, Beasley R (2004) The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 59:469–478

    Article  PubMed  Google Scholar 

  33. Rossignoli A, Clavenna A, Bonati M (2007) Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000–2005. Eur J Clin Pharmacol 63:1099–1106

    Article  PubMed  Google Scholar 

  34. Coffman JM, Cabana MD, Halpin HA, Yelin EH (2008) Effects of asthma education on children’s use of acute care services: a meta-analysis. Pediatrics 121:575–586

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Dr. Marco Sequi for help in the statistical analysis.

Competing interests

None declared.

Author information

Authors and Affiliations

  1. Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Pharmacological Research Institute, via G. La Masa 19, 20156, Milan, Italy

    Marina Bianchi, Antonio Clavenna & Maurizio Bonati

Authors
  1. Marina Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Clavenna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Bonati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marina Bianchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bianchi, M., Clavenna, A. & Bonati, M. Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000–2009 period. Eur J Clin Pharmacol 66, 929–936 (2010). https://doi.org/10.1007/s00228-010-0845-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-010-0845-y

Keywords

Search

Navigation