Prescribing patterns of asthma controller therapy for children in UK primary care: a cross-sectional observational study

BMC Pulm Med. 2010 May 14;10:29. doi: 10.1186/1471-2466-10-29.

Abstract

Background: Asthma management guidelines recommend a stepwise approach to instituting and adjusting anti-inflammatory controller therapy for children with asthma. The objective of this retrospective observational study was to describe prescribing patterns of asthma controller therapies for children in a primary care setting.

Methods: Data from the UK General Practice Research Database were examined for children with recorded asthma or recurrent wheezing who, from September 2006 through February 2007, were < or = 14 years old at the time of a first asthma controller prescription after > or = 6 months without a controller prescription. We evaluated demographic characteristics, asthma duration, comorbidities, asthma-related health care resource use, and prescribed daily dose of controller medication. In addition, physicians for 635 randomly selected patients completed a survey retrospectively classifying asthma severity at the prescription date and describing therapy and health care utilization for 6 prior months.

Results: We identified 10,004 children, 5942 (59.4%) of them boys, of mean (SD) age of 8.0 (3.8) years. Asthma controller prescriptions were for inhaled corticosteroid (ICS) monotherapy for 9059 (90.6%) children; ICS plus long-acting beta2-agonist (LABA) for 698 (7.0%); leukotriene antagonist monotherapy for 91 (0.9%); ICS plus leukotriene antagonist for 55 (0.6%); and other therapy for 101 (1.0%), including 45 (0.45%) children who were prescribed LABA as monotherapy. High doses of ICS (> 400 microg) were prescribed for 44/2140 (2.1%) children < 5 years old and for 420/7452 (5.6%) children > or = 5 years. Physicians reported asthma severity as intermittent for 346/635 (55%) patients and as mild, moderate, and severe persistent for 159 (25%), 71 (11%), and 11 (2%), respectively (severity data missing for 48 [8%]). The baseline characteristics and controller therapy prescriptions of the survey cohort were similar to those of the full cohort.

Conclusions: Physician classifications of asthma severity did not always correspond to guideline recommendations, as leukotriene receptor antagonists were rarely used and high-dose ICS or add-on LABA was prescribed even in intermittent and mild disease. In UK primary care, monotherapy with ICS is the most common controller therapy at all levels of asthma severity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic Agonists / administration & dosage
  • Adrenergic Agonists / therapeutic use
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cross-Sectional Studies
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Leukotriene Antagonists / administration & dosage
  • Leukotriene Antagonists / therapeutic use
  • Male
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / trends*
  • Primary Health Care*
  • Retrospective Studies
  • Severity of Illness Index
  • United Kingdom

Substances

  • Adrenal Cortex Hormones
  • Adrenergic Agonists
  • Anti-Asthmatic Agents
  • Leukotriene Antagonists