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

Eur J Clin Pharmacol. 2010 Sep;66(9):929-36. doi: 10.1007/s00228-010-0845-y. Epub 2010 Jun 9.


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 <or=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 beta-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.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acetates / therapeutic use
  • Adolescent
  • Albuterol / analogs & derivatives
  • Albuterol / therapeutic use
  • Androstadienes / therapeutic use
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy
  • Beclomethasone / therapeutic use
  • Budesonide / therapeutic use
  • Canada / epidemiology
  • Child
  • Cromolyn Sodium / therapeutic use
  • Cyclopropanes
  • Drug Prescriptions / statistics & numerical data*
  • Ethanolamines / therapeutic use
  • Europe / epidemiology
  • Fluocinolone Acetonide / analogs & derivatives
  • Fluocinolone Acetonide / therapeutic use
  • Fluticasone
  • Humans
  • Italy / epidemiology
  • Prevalence
  • Quinolines / therapeutic use
  • Salmeterol Xinafoate
  • Sulfides
  • United States / epidemiology


  • Acetates
  • Androstadienes
  • Anti-Asthmatic Agents
  • Cyclopropanes
  • Ethanolamines
  • Quinolines
  • Sulfides
  • Fluocinolone Acetonide
  • Budesonide
  • Salmeterol Xinafoate
  • flunisolide
  • Fluticasone
  • Beclomethasone
  • montelukast
  • pirbuterol
  • Cromolyn Sodium
  • Albuterol