How pediatricians in Spain manage the first acute wheezing episode in an atopic infant. Results from the TRAP study.
BACKGROUND
Although the treatment of asthma has been addressed in several guidelines, the management of the first acute wheezing episode in infants has not often been evaluated. We surveyed practicing pediatricians in Spain about the treatment they would provide in a simulated case.


METHODS
A random sample of 3000 pediatricians and physicians who normally treated children was surveyed. The questionnaire inquired about how they would treat a first mild-to-moderate wheezing attack in a 5-month-old boy with a personal and family history of allergy. Pediatricians were asked about their professional background.


RESULTS
A total of 2347 questionnaires were returned with useful data (78.2%). Most (90.4%) of the pediatricians would use a short-acting beta2 agonist (SABA) via a metered-dose inhaler with a spacer and a face mask or nebulizer. However, only 34.5% chose a SABA alone: 31.3% added an oral steroid and 27.6% added an inhaled corticosteroid (ICS). The factors associated with the use of ICS in the acute attack were: (1) lack of specific training in pediatrics (OR 1.45; 1.12-1.85) and (2) primary care health center setting (OR 1.31; 1.01-1.69) or rural setting (OR 1.28; 1.01-1.66). Forty-four percent did not recommend any follow-up treatment while 20.7% prescribed ICS as maintenance therapy. The factors related to this decision were the same as those described above.


CONCLUSIONS
The management of a first wheezing episode seems to meet published guidelines among Spanish pediatricians with formal training in pediatrics and in those who work in a hospital setting or in urban areas.
Castro-Rodríguez
J A
JA
Pediatric Respiratory Medicine Dept., School of Medical Sciences, University of Santiago de Chile, Chile.
Escribano Montaner
A
A
Garde Garde
J
J
Morell Bernabé
J J
JJ
Pellegrini Belinchón
J
J
Garcia-Marcos
L
L
D000208:Acute Disease; D000280:Administration, Inhalation; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D058672:Adrenergic beta-2 Receptor Antagonists; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D001986:Bronchial Spasm / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D019090:Case Management / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003625:Data Collection; D004359:Drug Therapy, Combination; D019983:Guideline Adherence; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007223:Infant; D036503:Inhalation Spacers; D008397:Masks; D036501:Metered Dose Inhalers; D010372:Pediatrics / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D012135:Respiratory Sounds; D013030:Spain; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D058672:Adrenergic beta-2 Receptor Antagonists; D000319:Adrenergic beta-Antagonists; D018927:Anti-Asthmatic Agents