Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000-2009 period.
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.
Bianchi
Marina
M
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@marionegri.it
Clavenna
Antonio
A
Bonati
Maurizio
M
D000085:Acetates / Q000627:therapeutic use; D000293:Adolescent; D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D000730:Androstadienes / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy; D001507:Beclomethasone / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002648:Child; D004205:Cromolyn Sodium / Q000627:therapeutic use; D003521:Cyclopropanes; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004983:Ethanolamines / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005446:Fluocinolone Acetonide / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068298:Fluticasone; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015995:Prevalence; D011804:Quinolines / Q000627:therapeutic use; D000068299:Salmeterol Xinafoate; D013440:Sulfides; D014481:United States / Q000453:epidemiology
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D004983:Ethanolamines; D011804:Quinolines; D013440:Sulfides; D005446:Fluocinolone Acetonide; D019819:Budesonide; D000068299:Salmeterol Xinafoate; C007734:flunisolide; D000068298:Fluticasone; D001507:Beclomethasone; C093875:montelukast; C009118:pirbuterol; D004205:Cromolyn Sodium; D000420:Albuterol