Airway symptoms and atopy in young children prescribed asthma medications: A large‐scale cohort study

Abstract

Diagnosing asthma and deciding treatment are difficult in young children. An inappropriate and too high prescription rate of inhaled corticosteroids (ICS) is suggested, but how airway symptoms are associated with prescriptions of asthma medication is less known. We studied how strongly wheeze, lower respiratory tract infections (LRTI), and atopic diseases are associated with dispensing of asthma medications during early childhood. We used data from the Norwegian Mother and Child Cohort Study and the Norwegian Prescription Database at four age‐intervals (0‐6, 6‐18, 18‐36 months, and 3‐7 years). Primary outcomes were dispensed asthma medications (no medication, short‐acting β‐2 agonist, or ICS). Relative risks (RRs) and average attributable fractions (AAFs) were estimated. Both wheeze and LRTI were positively associated with both medication groups (0‐6 months: no data on wheeze). The RRs and AAFs were higher for wheeze than LRTI. For ICS, the AAFs (95% CI) for wheeze vs LRTI were: 6 to 18 months: 69.2 (67.2, 71.2)% vs 10.4 (9.0, 11.8)%, 18 to 36 months: 33.0 (30.5, 35.5)% vs 10.0 (8.0, 12.0)%, and 3 to 7 years: 33.7 (31.0, 36.5)% vs 1.2 (0.5, 1.9)%. Except at 3 to 7 years of age, the AAFs were lower for atopic diseases than for LRTI and wheeze. Atopic diseases modified the associations between wheeze and ICS at 18 to 36 months and between LRTI or wheeze and ICS at 3 to 7 years. In conclusion, both wheeze and LRTI were associated with prescriptions of asthma medications in young children, with the strongest associations seen for wheeze. Atopic diseases contributed to these associations only in the oldest age groups.

Montelukast: results and prospects for applications in pediatric practice

“…Многие авторы признают, что паттерны wheezing (свистящих хрипов) у детей дошкольного возраста меняются с течением времени и на фоне проводимой противовоспалительной терапии [34,38]. АЛТР и иГКС могут предотвращать свистящее дыхание у дошкольников с АР и рецидивирующими хрипами [37].…”

Preschool Wheezing: Trajectories and Long-Term Treatment

“…In interpreting these findings it should be considered that prescription of ICS is frequent in children with low tract respiratory infections who do not wheeze. Therefore, choosing the appropriate pharmacological treatment in children with airways disorders is still challenging, a correct diagnostic work up is crucial to avoid inadequate prescriptions (86,87).…”

Small airway dysfunction is an independent dimension of wheezing disease in preschool children

“…2 On the contrary, wheeze has been associated with prescriptions of asthma medications in young children, which could lead to an inappropriate and too high prescription rate of inhaled corticosteroids. 3 We recently showed that small airway dysfunction (SAD: increased peripheral resistance and decreased peripheral compliance of the respiratory system) was an almost constant finding in asthmatic children with increased interrupter resistance. 4 One may hypothesize that SAD markers obtained from a more sensitive method than spirometry, namely impulse oscillometry, [5][6][7] could be linked to asthma probability.…”

“…This issue is important given the possible underestimation of asthma prevalence in preschool children 2 . On the contrary, wheeze has been associated with prescriptions of asthma medications in young children, which could lead to an inappropriate and too high prescription rate of inhaled corticosteroids 3 …”