Astma bij kinderen: hoe zeker is de diagnose?

Pouwelse, Marinka; Meer, Victor van der; Boogaard, Maria van den; Hugen, Cory M.; Merkus, Peter; Bemt, Lisette van den

doi:10.1007/s12445-015-0220-4

Cited by 3 publications

(10 citation statements)

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“…Overtreatment is consequently the result of overdiagnosis. In literature high prevalence of overdiagnosis and thereby overtreatment has been reported in both non-obese and obese adults, and children [5, 13, 17]. Two recent studies performed in primary healthcare centers in the Netherlands, reassessed whether the asthma diagnosis in children was given correctly and whether pharmacological asthma therapy was indicated [5, 17].…”

Section: Discussionmentioning

confidence: 99%

“…In literature high prevalence of overdiagnosis and thereby overtreatment has been reported in both non-obese and obese adults, and children [5, 13, 17]. Two recent studies performed in primary healthcare centers in the Netherlands, reassessed whether the asthma diagnosis in children was given correctly and whether pharmacological asthma therapy was indicated [5, 17]. Both studies evaluated the validity of registered asthma diagnosis based on information on asthma-related characteristics reported in medical files such as (episodic) wheezing, dyspnea, cough, family history for atopic diseases, sensitivity for non-specific irritants, allergy test, and reversibility in pulmonary function test [5, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies performed in primary healthcare centers in the Netherlands, reassessed whether the asthma diagnosis in children was given correctly and whether pharmacological asthma therapy was indicated [5, 17]. Both studies evaluated the validity of registered asthma diagnosis based on information on asthma-related characteristics reported in medical files such as (episodic) wheezing, dyspnea, cough, family history for atopic diseases, sensitivity for non-specific irritants, allergy test, and reversibility in pulmonary function test [5, 17]. Based on an algorithm of combination of symptoms, Pauwelse classified patients into probable asthma, unlikely asthma, and insufficient data for the diagnose asthma [5, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Both studies evaluated the validity of registered asthma diagnosis based on information on asthma-related characteristics reported in medical files such as (episodic) wheezing, dyspnea, cough, family history for atopic diseases, sensitivity for non-specific irritants, allergy test, and reversibility in pulmonary function test [5, 17]. Based on an algorithm of combination of symptoms, Pauwelse classified patients into probable asthma, unlikely asthma, and insufficient data for the diagnose asthma [5, 17]. Looijmans classified patients as confirmed, probable, unlikely, and no asthma [5, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Recently high prevalence of overdiagnosis of asthma in children was reported, in primary healthcare centers in the Netherlands [5, 17]. However, little is known about the prevalence of overdiagnosis and consequently overtreatment of asthma in pediatric populations with overweight/obesity in pediatric outpatient clinics.…”

Section: Introductionmentioning

confidence: 99%

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Asthma medication in children who are overweight/obese: justified treatment?

et al. 2019

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Background The prevalence of asthma and obesity have increased over the last decades. A possible association between these two chronic illnesses has been suggested, since the prevalence of asthmatic symptoms rises with increasing Body Mass Index (BMI). However, asthma is only one of several possible causes of shortness of breath in obese children. The aim of this study is to evaluate the prevalence of overtreatment with asthma medication in a cohort overweight/obese children with respiratory symptoms visiting a pediatric outpatient clinic. Methods Children referred to a pediatric outpatient clinic aged ≥4- ≤ 18 years with overweight/obesity (defined as BMI-sds > 1.1) and asthmatic symptoms were included. The diagnosis asthma was evaluated and classified in no, unlikely, probable and confirmed asthma, based on clinical parameters and/or spirometry results. Overtreatment was defined as asthma medication prescribed in participants classified as no or unlikely asthma. And undertreatment as probable or confirmed asthma without asthma medication prescribed . Results Three hundred thirty-eight participants were included, of which 92.6% (313/338) had a prescription for asthma medication. Overtreatment was observed in 27.2% (92/338) participants. Nine participants were undertreated. Conclusion More than 25% overtreatment with asthma medication was observed in a cohort overweight/obese children with asthmatic symptoms. This finding emphasizes that the diagnosis of asthma must be confirmed before commencement of medication. The diagnosis of asthma should be based on standard questionnaires evaluating asthmatic symptoms, lung functions test and regular reassessments. Further studies concerning overtreatment with asthma medication in normal weight pediatric populations are warranted, to evaluate whether overtreatment is specific for overweight/obese children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Asthma medication in children who are overweight/obese: justified treatment?

et al. 2019

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Astma bij kinderen: een praktijkverbeterplan waardig

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Huisarts Wet

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beleid eveneens. De behandeling is gericht op het verminderen van de luchtwegsymptomen en daarmee op verbetering van de kwaliteit van leven. Een vroege start van luchtwegmedicatie heeft geen positieve invloed op de prognose van astma of op de longfunctie op latere leeftijd. Afhankelijk van de ernst van de klachten kan gestart worden met alleen een luchtwegverwijder. Bij herhaling of persisterende klachten is een combinatie met een inhalatiecorticosteroïd (ICS) een optie.Maar hier gaan we als huisartsen toch met regelmaat de fout in. Wat een proefbehandeling zou moeten zijn en dus om een controle van het effect vraagt, eindigt te vaak in verkeerd of te langdurig gebruik van medicatie. Uit onderzoek naar het voorschrijfgedrag van huisartsen bij kinderen (2-12 jaar) met luchtwegklachten bleek dat te vaak direct met ICS gestart werd en het gebruik gecontinueerd werd, zonder dat de diagnose astma waarschijnlijk was. Kortdurende voorschriften van ICS zonder adequate follow-up vormden de dagelijkse praktijk. 2 Ook in het PIAMA-onderzoek, een groot Nederlands geboortecohort, bleek maar liefst 36% van de kinderen (2-8 jaar) die ICS gebruikten in de afgelopen 2 jaar geen astmagerelateerde klachten te hebben gehad. Bij meer dan de helft van de kinderen was nooit een diagnose astma gesteld, ondanks frequent ICS-gebruik. 3 Beide Nederlandse onderzoeken maken duidelijk dat er werk aan de winkel is als het gaat om het voorschrijven en monitoren van inhalatiemedicatie bij kinderen. Overdiagnostiek en overregistratieIn het onderzoek van Pouwelse is in zeven Brabantse huisartspraktijken onderzocht wat de betrouwbaarheid is van de geregistreerde diagnose astma (R96) bij kinderen tussen de 6 en 16 jaar. 4 Bij 9% van de onderzochte kinderen was een astma-code in het HIS geregistreerd. Slechts bij 92 (42%) van de 218 kinderen met een compleet medisch dossier waren aanwijzingen voor astma in het dossier te vinden. Bij 28 (13%) kinderen was de diagnose astma onwaarschijnlijk en bij 98 (45%) kinderen kon geen uitspraak gedaan worden over de validiteit van de diagnose astma. De conclusie is dat de diagnose astma niet bevestigd kon worden bij een meerderheid van de kinderen met code R96. Bij jonge kinderen of kinderen bij wie op jongere leeftijd R96 was vastgelegd bleek het vaker onmogelijk de diagnose te verifiëren. De onderzoekers concluderen terecht dat de diagnostiek van astma bij kinderen en de registratie hiervan in de huisartsenpraktijk meer aandacht verdienen. Een vergelijkbaar onderzoek in Utrechtse praktijken liet eveneens zien dat de diagnose astma bij meer dan de helft van de kinderen (6-18 jaar) met astmamedicatie en/of code R96 onwaarschijnlijk was. 5 Overregistratie en overdiagnostiek van astma bij kinderen vormen een serieus probleem in de Nederlandse huisartsenpraktijk.D e huisarts stelt bij kinderen niet vaak een chronische ziekte vast. Maar als het gebeurt, is het meestal astma. Inhalatiemedicatie voor de luchtwegen staat al jaren in de top van de medicijnuitgaven in Nederland, waarbij de dure combinatiepreparaten de ran...

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Protocolled practice nurse-led care for children with asthma in primary care: protocol for a cluster randomised trial

et al. 2019

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IntroductionIn children with asthma, daily symptoms and exacerbations have a significant impact on the quality of life of both children and parents. More effective use of asthma medication and, consequently, better asthma control is advocated, since both overtreatment and undertreatment are reported in primary care. Trials in adults suggest that asthma control is better when patients receive a regular medical review. Therefore, protocolled care by the general practitioner may also lead to better asthma control in children. However, such protocolled care by the general practitioner may be time consuming and less feasible. Therefore, this study aims to determine whether protocolled practice nurse-led asthma care for children in primary care provides more effective asthma control than usual care.Methods and analysisThe study will be a cluster-randomised open-label trial with an 18-month follow-up. Practice nurses will be the units of randomisation and children with asthma the units of analysis. It is planned to include 180 children aged 6–12 years. Primary outcome will be average asthma control during the 18-month follow-up measured by the Childhood Asthma Control Test (C-ACT). Secondary outcomes include C-ACT scores at t=3, t=6, t=12 and t=18 months; the frequency and severity of exacerbations; cost-effectiveness; quality of life; satisfaction with delivered care; forced expiratory volume in 1 s and forced expiratory flow at 75% and the association of high symptoms scores at baseline and baseline characteristics. Besides, we will conduct identical measurements in a non-randomised sample of children.Ethics and disseminationThis will be the first trial to evaluate the effectiveness of protocolled practice nurse-led care for children with asthma in primary care. The results may lead to improvements in asthma care for children and can be directly implemented in revisions of asthma guidelines.The study protocol was approved by the Medical Research Ethics Committee of the Erasmus Medical Centre in Rotterdam.Trial registrationNTR6847.

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Astma bij kinderen: hoe zeker is de diagnose?

Cited by 3 publications

References 5 publications

Asthma medication in children who are overweight/obese: justified treatment?

Asthma medication in children who are overweight/obese: justified treatment?

Astma bij kinderen: een praktijkverbeterplan waardig

Protocolled practice nurse-led care for children with asthma in primary care: protocol for a cluster randomised trial

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