Asthma-related medication use among children in the United States

Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000–2009 period

“…Only ten articles met inclusion criteria (6%). After identification of two additional studies through a manual reference search (they were not retrieved using the database search because not indexed with "anti-asthmatic agents" or "asthma" as a keyword), twelve pharmaco-epidemiological studies [9,10,[21][22][23][24][25][26][27][28][29][30] met the inclusion criteria ( Figure 1). The studies were carried out from 1998 to 2006 in six countries: Italy and The Netherlands (three studies each), Denmark and Norway (two studies each), Canada and US (one each) ( Table 1).…”

“…179 were excluded because specific to a single antiasthmatic drug, or a single anti-asthmatic drug subclass, or they only analysed the quality of prescriptions or were done before 1998 and ten articles were suitable for analysis. After 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w 7 identification of two additional studies through a manual reference search (they were not retrieved using the database search because not indexed with "anti-asthmatic agents" or "asthma" as a keyword), twelve pharmaco-epidemiological studies [9,10,[21][22][23][24][25][26][27][28][29][30] met the inclusion criteria ( Figure 1). (see Table I) The studies were carried out from 1998 to 2006 in six countries: Italy and The Netherlands (three studies each), Denmark and Norway (two studies each), Canada and US (one each) ( Table 1).…”

“…Only two countries reported distribution, analyzing the number of packages of anti-asthmatic drugs prescribed during the period studied: only 29% of Italian [21] and 26% of Dutch [30] subjects received three or more packages. Four articles [21,26,27,30] reported close similar percentages for oral steroids, from 4.0% to 4.7%. In only two articles the prevalence of anti-asthmatic prescription was checked against the diagnosis of asthma [28,30], and in both it was double.…”

“…beclomethasone and salbutamol in Italy [21,22], salbutamol and fluticasone in Canada [26], salbutamol and montelukast in the US [27]. In Italy, beclomethasone and salbutamol are both prescribed mainly as nebulised suspension [21].…”

“…However, even in the countries where AP asthma prevalence and PP prescription prevalence are similar, the suggestion that anti-asthmatics are prescribed somewhere for diseases other than asthma too is still valid because in two studies [20,25] measured that half the subjects received only one packages of anti-asthma drugs per year, suggestive of non-asthmatic illness. Although there were two articles reporting diagnosis of asthma [27,29] from countries (Denmark and The Netherlands) where the prevalence of asthma is low, the gap between PP prescription prevalence and burden of disease was large, with the number of cases diagnosed only half the number of cases treated. Since asthma is more reliably diagnosed in children from the age of six, the discrepancy between prescriptions and actual disease does not necessarily suggest inadequacies of prescription, but points to anti-asthma drug use as therapy in the youngest patients, when asthma is suspected but not diagnosed yet.…”