title: Assessment of pediatric asthma drug use in three European countries; a TEDDY study.
abstract: Asthma drugs are amongst the most frequently used drugs in childhood, but international comparisons on type and indication of use are lacking. The aim of this study was to describe asthma drug use in children with and without asthma in the Netherlands (NL), Italy (IT), and the United Kingdom (UK). We conducted a retrospective analysis of outpatient medical records of children 0-18 years from 1 January 2000 until 31 December 2005. For all children, prescription rates of asthma drugs were studied by country, age, asthma diagnosis, and off-label status. One-year prevalence rates were calculated per 100 children per patient-year (PY). The cohort consisted of 671,831 children of whom 49,442 had been diagnosed with asthma at any time during follow-up. ß2-mimetics and inhaled steroids were the most frequently prescribed asthma drug classes in NL (4.9 and 4.1/100 PY), the UK (8.7 and 5.3/100 PY) and IT (7.2 and 16.2/100 PY), respectively. Xanthines, anticholinergics, leukotriene receptor antagonists, and anti-allergics were prescribed in less than one child per 100 per year. In patients without asthma, ß2-mimetics were used most frequently. Country differences were highest for steroids, (Italy highest), and for ß2-mimetics (the UK highest). Off-label use was low, and most pronounced for ß2-mimetics in children <18 months (IT) and combined ß2-mimetics + anticholinergics in children <6 years (NL).
  
  
  CONCLUSIONS
  This study shows that among all asthma drugs, ß2-mimetics and inhaled steroids are most often used, also in children without asthma, and with large variability between countries. Linking multi-country databases allows us to study country specific pediatric drug use in a systematic manner without being hampered by methodological differences. This study underlines the potency of healthcare databases in rapidly providing data on pediatric drug use and possibly safety.
authors.affiliation: Department of Medical Informatics, Erasmus University Medical Center, Suite Ee 21.55, Dr Molewaterplein 50, PO Box 2040, 3000 CA Rotterdam, The Netherlands. e.f.sen@erasmusmc.nl
authors.forename: Elif Fatma
authors.initials: EF
authors.lastname: Sen
authors.forename: Katia M C
authors.initials: KM
authors.lastname: Verhamme
authors.forename: Antje
authors.initials: A
authors.lastname: Neubert
authors.forename: Yingfen
authors.initials: Y
authors.lastname: Hsia
authors.forename: Macey
authors.initials: M
authors.lastname: Murray
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Felisi
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.forename: Geert W
authors.initials: GW
authors.lastname: 't Jong
authors.forename: Gino
authors.initials: G
authors.lastname: Picelli
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Nicolosi
authors.forename: Adriana
authors.initials: A
authors.lastname: Ceci
authors.forename: Ian C
authors.initials: IC
authors.lastname: Wong
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D003345:Corticosterone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D009426:Netherlands; D056687:Off-Label Use; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D000318:Adrenergic beta-Agonists; D018926:Anti-Allergic Agents; D018680:Cholinergic Antagonists; D003345:Corticosterone
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