Spirometry monitoring in asthmatic children in Lombardy Region, Italy

Abstract

ObjectivesTo evaluate the diagnostic and therapeutic approaches in a cohort of asthmatic children before and after starting drug therapy.MethodsData were retrieved from administrative databases of the Lombardy Region. The study population was composed of 78 184 children born in the Lombardy Region in 2002 and followed until their 10th birthday.Children with at least one antiasthmatic drug prescription per year (with the exclusion of nebulised suspension/solution formulations) in 2 consecutive years and at least one antiasthmatic drug prescription after the fifth birthday were identified as potential asthmatics (PA).Each PA was monitored for a period starting from 12 months before and ending 24 months after the first prescription (index prescription, IP). During the monitoring period antiasthmatic drug prescriptions were analysed, as well as spirometry and/or specialist visits.ResultsA total of 59 975 children (76.7%) received ≥1 prescription of antiasthmatic drugs in their first 10 years of life, and 4475 (5.7%) were identified as PAs. In all, 24% of PAs started with short-acting β2-agonists (SABA), 23% with inhaled corticosteroids (ICS) and 20% with SABA+ICS.A total of 33% of PAs had at least one prescription for specialist visit/spirometry: 11% before and 28% after the IP. The factors associated with a greater likelihood of receiving visit/spirometry prescriptions were local health unit of residence, age and high use of asthma drugs.ConclusionsDespite international guideline recommendations, spirometry monitoring is still underused in asthmatic children, even in subjects who initiated pharmacological treatment and therefore need an airway function evaluation. Moreover, the choice of drug therapy appears not always rational, since one out of four children were commenced on ICS as monotherapy.

Does routine spirometry impact on clinical decisions and patient-related outcome measures of children seen in respiratory clinics: an open-label randomised controlled trial

“…One of the main reasons spirometry is under-used is that children may find the manoeuvre difficult to perform, and the success rates in the younger age groups may be low 9 10. A study reported that only 32.4% of children aged 5–8 years with potential asthma had at least one spirometry undertaken either in the year before (6.4%) or the 2 years after (29.7%) the first asthma treatment 11. Moreover, only one-third of children with asthma were referred for spirometry,12 and only half of children hospitalised with asthma underwent spirometry during follow-up 13.…”

“… 9 10 A study reported that only 32.4% of children aged 5–8 years with potential asthma had at least one spirometry undertaken either in the year before (6.4%) or the 2 years after (29.7%) the first asthma treatment. 11 Moreover, only one-third of children with asthma were referred for spirometry, 12 and only half of children hospitalised with asthma underwent spirometry during follow-up. 13 Others found that only 10–21% of general practitioners and paediatricians used spirometry consistently in childhood asthma management.…”