High incidence of oral corticosteroids prescriptions in children with asthma in early childhood

Arabkhazaeli, Ali; Vijverberg, Susanne J. H.; Ent, Cornelis K. van der; Raaijmakers, J. A. M.; Zee, Anke‐Hilse Maitland‐van der

doi:10.1080/02770903.2016.1185439

Cited by 14 publications

(16 citation statements)

References 13 publications

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“…In an analysis of health plan computerised claims data, 2-5% of children with asthma received three or more bursts per year, with more in the youngest (aged 1-8 years) than in the oldest children [91]. The frequent repeated prescription of OCS bursts in preschool-aged children with asthma (<4years of age) was also shown in a Dutch study [92]. In the school-aged children with severe asthma from the U-BIOPRED cohort, the median was 3 severe exacerbations requiring OCSs in the previous year [90].…”

Section: Paediatric Aspectsmentioning

confidence: 80%

How can we minimise the use of regular oral corticosteroids in asthma?

et al. 2020

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Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key “research statement proposals” were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn’t be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year−1 should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.

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Section: Paediatric Aspectsmentioning

confidence: 80%

How can we minimise the use of regular oral corticosteroids in asthma?

et al. 2020

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“…In a Dutch study based on pharmacy data, more than 25% of asthmatic children were prescribed oral CS during a year of follow‐up; the risk of a second and even a third CS course during the same year was increased in infants, during their first year of life . Such finding was confirmed in an American retrospective study, reporting that children receiving the biggest amount of oral CS prescriptions were those aged 1‐4 years .…”

Section: Corticosteroids In Preschool Children With Wheezingmentioning

confidence: 82%

Oral corticosteroids and asthma in children: Practical considerations

Filippo

Clark

Fillard

et al. 2020

Pediatric Allergy Immunology

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When dealing with allergic disorders, pediatricians may prescribe systemic corticosteroids (CS) to treat several different diseases, such as asthma, allergic rhinitis, allergic conjunctivitis, angioedema, eczema, certain types of food allergy, and anaphylaxis, and to prevent a delayed response. The main effects for which they are used in allergy are their anti-inflammatory effect, their ability to relax smooth muscle cells, and their action on the allergic delayed response. In clinical practice, corticophobia may raise doubts in patients and their families. For such reason, it is essential to well educate children and their caregivers: In a study by Najada et al, the authors showed that an appropriate education in managing asthma in children allowed a significant reduction in acute care visits and hospitalizations. 1 Here, we will focus on the prescription of oral CS in children with asthma and wheezing. | PHARMACOK INE TI C S AND S IDE EFFEC TSCorticosteroids bound to two plasma proteins: a corticosteroid-binding globulin (also called "transcortin") and albumin. Nevertheless, only the unbound free fraction is biologically active. 2 CS metabolism is essentially hepatic, being catalyzed by enzymes of the cytochrome P450 family. The pharmacokinetics of CS does not differ between asthmatic and non-asthmatic patients. 2The main side effects of CS in the pediatric population include growth impairment, pubertal disorders, and hirsutism. In adults, the main side effects include acne, delayed cicatrization, the possible appearance of glaucoma, and posterior cataract, and increase the risk of bone fracture. At any age, the use of CS is associated with an increased risk of diabetes, hypertension, and virus reactivation. 2 There are always concerns about CS prescription and the risk of adrenal dysfunction. In a Brazilian study, the authors showed that even the use of CS for short-term courses is associated with an increased risk of transitory suppression of the

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“…In the Netherlands, a longitudinal follow-up study of 2272 children 4 to 12 years of age who were regular users of asthma medication found that 25.7% of their sample was prescribed an OCS. 9 to 2006. 18 Our rates were similar to the 48.7% observed among infants with wheezing in the first year of life in the city of Belo Horizonte, Brazil.…”

Section: Resultsmentioning

confidence: 99%

“…8 Concerns have begun to be raised about high rates of OCS prescribing among children with asthma. 9 Texas Children's Health Plan (TCHP) is a large, not-for-profit Medicaid and Children's Health Insurance Program (CHIP) managed care organization serving the greater Harris and Jefferson county areas in East Texas, including the cities of Houston and Beaumont/Port Arthur. The specific aim of this study is to describe the rates of OCS dispensing among children with asthma who were enrolled in TCHP and to determine patient and provider factors associated with variation in OCS dispensing.…”

mentioning

confidence: 99%