Children with asthma on inhaled corticosteroids managed in general practice or by hospital paediatricians: is there a difference?

Abstract

Aim: To investigate whether there are differences in asthma characteristics between two populations of children with moderate asthma requiring inhaled corticosteroids (ICS) who are treated in general practice or in hospital practice.Patients and Methods: 45 children from general practice and 62 from hospital practice, diagnosed with asthma and treated with ICS, were analysed in terms of lung function parameters, asthma control (ACQ), and use of medication.Results: Children in general practice did not differ significantly from those in paediatric practice with respect to mean age, lung function tests, and corrected daily dose of ICS. The median ACQ score was higher (representing poorer control) in the general practice group than in the paediatric practice group (0.67 and 0.33 respectively, p < 0.05). Fewer children (22.7%) from the general practice group than from the paediatric group (98.4%) had planned review visits (p< 0.01). Prescriptions for a combination ICS/long-acting β2-agonist (LABA) inhaler were 28.9% in the general practice group and 6.5% in the paediatric group (p<0.05). Conclusion:The hospital-based group was better controlled with less frequent use of combination therapy. Our observations stress the necessity for regular review visits for children with moderately severe asthma especially in general practice.

Lack of self perception of illness in children with asthma: the real reason for referral?

“…It has to be considered that not only predictors concerning the illness itself -such as the ACQ in this studybut also the perception of the patient (or parents in the case of young children) about his or her illness, should be part of future studies. 5,6 Till then, the results of this study 3 will be discussed during future training programs. This study should give food for thought and engender a less emotional and more rational discussion; if we, as GPs, want our patients to get better, we should first of all improve our knowledge as well as our patients' perception of their illness.…”

“…by Kuethe et al has been completed and published in this issue of the Primary Care Respiratory Journal. 3 I am convinced that this study will be presented in many training programs for GPs, and paediatricians as well, and that it will find its way into several guidelines. Of course, more studies in this field will be initiated because they are so desperately needed.…”

“…3 Interesting, because we have to realise from our knowledge of daily practice that some of our chronically ill patients are in favour of being referred to a specialist, in this case the paediatrician. The question is: which patients derive benefit?…”

Monitoring asthma in childhood: management-related issues

“…Scheduled close follow-up of children with asthma, providing repeated tailored education, agreement on treatment goals and methods, and addressing patients' and parents' beliefs and concerns, helps to improve asthma control [6,9,10]. As adherence to ICS is strongly associated with asthma control, improving adherence, compared to any improvement in specific medical treatment, may be the most cost-effective way to improve asthma control [11,12].…”

Adherence: Its Role in Achieving Control Over Bronchial Asthma in Children

“…Для хорошего контроля над астмой и более высокой приверженности необходим также междисциплинарный подход -привлечение в процессе лечения средне-го медицинского персонала и специалистов смежных специальностей, что повышает степень самоконтроля и уровень образования пациента и родителя в вопросах болезни [10,14,53]. Одним из звеньев междисципли-нарного подхода является работа психолога с семьей больного ребенка [2].…”