title: Asthma symptoms and medication in the PIAMA birth cohort: evidence for under and overtreatment.
abstract: OBJECTIVE
  Under and overtreatment of asthma may be a serious problem especially in young children, but the evidence is scarce and no longitudinal data are available. Our aim was to investigate whether inhaled medication use in young children was in agreement with asthma symptoms at the age of 2-8 yr.
  
  
  METHODS
  Data were used from the 'Prevention and Incidence of Asthma and Mite Allergy' birth cohort, consisting of 3963 children born in the Netherlands. Between age 2 and 8 yr, children were followed up using annual postal questionnaires. Age-specific prevalences of asthma symptoms were assessed and compared with reported use of inhaled bronchodilators and/or corticosteroids.
  
  
  RESULTS
  The proportion of current wheeze decreased with age. About a third of 'current wheezers' did not use any inhaled medication during the years in which symptoms were reported. At 8 yr, 30% of children with reported 'severe current asthma symptoms' were not using inhaled corticosteroids. On the other hand, up to 50% of children with inhaled corticosteroids for at least 2 yr did not report any wheezing during those 2 yr.
  
  
  CONCLUSIONS
  The proportion of symptomatic children without appropriate treatment was substantial throughout childhood, even when parents reported prolonged or severe symptoms. Treatment of asymptomatic children with inhaled corticosteroids increased with age and accounted for up to a third of all inhaled steroid use at 8 yr. These findings suggest that under and overtreatment of asthma in children was common.
authors.affiliation: Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Caudri
authors.forename: Alet H
authors.initials: AH
authors.lastname: Wijga
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Smit
authors.forename: Gerard H
authors.initials: GH
authors.lastname: Koppelman
authors.forename: Marjan
authors.initials: M
authors.lastname: Kerkhof
authors.forename: Maarten O
authors.initials: MO
authors.lastname: Hoekstra
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000818:Animals; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004417:Dyspnea / Q000188:drug therapy; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008925:Mites / Q000276:immunology; D009426:Netherlands / Q000453:epidemiology; D012135:Respiratory Sounds; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents