The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands.
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 beta2-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 beta2-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 beta2-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.
de Vries
Tjalling W
TW
Department of Paediatrics, Medical Centre Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands. tjalling.de.vries@znb.nl
Tobi
Hilde
H
Schirm
Eric
E
van den Berg
Paul
P
Duiverman
Eric J
EJ
de Jong-van den Berg
Lolkje T W
LT
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D017723:Drug Utilization Review; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D036501:Metered Dose Inhalers; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards*
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents