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Childhood asthma still inappropriately treated in the UK

Children with asthma are missing out on the best drug treatment for their disease, because family doctors are ignoring prescribing guidelines, suggests research published ahead of print in the Archives of Disease in Childhood.

Around a million children in the UK have asthma, and the disease prompts up to a third of children aged between 5 and 13 to visit their doctor.

The researchers used national data to calculate the number of prescriptions issued for asthma drugs by doctors working in the community in the UK between 2000 and 2006.

These figures were then matched with guidance issued by the British Thoracic Society (BTS), updated in 2005, on the most appropriate drug treatments for children with asthma.

The guidance discourages the use of syrups designed to open up the airways (bronchodilator syrups), because they have a systemic rather than a targeted effect, and dont actually control asthma symptoms very well.

But the figures showed that although prescriptions for this type of medication fell by 60%, 121,000 prescriptions for the medicine were still written in 2006.

Despite concerns about the effects of long acting beta agonists (LABAs) in children, and recommendations to curb their use, the total number of these prescriptions almost doubled.

And the percentage of prescriptions for combination inhalers, containing steroid and a LABA, rose 7-fold from 2.6% to 20.5%.

The BTS guidance recommends that combination inhalers should be used only when appropriate dose steroid inhalers fail to control the asthma adequately (persistent asthma).

Persistent asthma accounts for only 5 to 10% of childhood asthma, say the authors.

The authors note that the changes in prescribing practice are unlikely to be the result of an increase in the prevalence of asthma.

Nor are they likely to be attributable to population changes, because children under the age of 18 in the UK fell between 2000 and 2006, they say.

Contact: Emma Dickinson
BMJ Specialty Journals

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