The objectives of this study is to compile current knowledge about asthma control in children in relation to goals proposed in international guidelines, to elucidate the factors associated with insufficient asthma control and to address the implications for clinical practice. Review of recent worldwide large population epidemiological surveys and clinical asthma studies of more than 20,000 children are the methods used in this study. The studies report high frequencies of sleep disturbances, emergency visits, school absence and limitations of physical activity due to asthma. Only a small percentage of children with asthma reach the goals of good asthma control set out by Global Initiative for Asthma (GINA). There is evidence of underuse of inhaled corticosteroids even in children with moderate or severe persistent asthma and over-reliance on short-acting beta(2)-agonist rescue medication. Both parents and physicians generally overestimate asthma control and have low expectations about the level of achievable control. Many children with asthma are not being managed in accordance with guideline recommendations, and asthma management practices vary widely between countries. Asthma control falls short of guideline recommendations in large proportions of children with asthma worldwide. Simple methods for assessing asthma control in clinical practice are needed. Treatment goals based on raised expectations should be established in partnership with the asthmatic child and the parents. Effective anti-inflammatory treatment should be used more frequently, and patients should be reviewed regularly.
Frequent need for emergency healthcare indicates poor asthma control and consumes resources that might be better spent on improved management. This study estimated the cost of scheduled and unscheduled healthcare for asthma in seven European Union (EU) countries.The occurrence of asthma-related healthcare resource use and asthma symptom severity were identified from a telephone sample of people with asthma in France, Germany, Italy, the Netherlands, Spain, Sweden and the UK. Healthcare resource use was multiplied by countryspecific unit costs to estimate per patient annual expenditure. Patients were divided into four groups according to asthma symptom severity: mild intermittent symptoms, mild persistent symptoms, moderate persistent symptoms and severe persistent symptoms. Cost was divided between scheduled and unscheduled care. Drug cost was not evaluable.The study included 2,803 patients, of whom 1,695 (60%) reported mild symptoms and 2,050 (73%) were aged o16 yrs. The average annual per patient cost was J789 for patients aged 0-4 yrs, J463 for patients aged 5-15 yrs and J566 for adults. Unscheduled care accounted for 47% of total cost in infants, 45% in children and 56% in adults.Around half of expenditure on asthma management was found to be due to unscheduled care regardless of the severity of patient symptoms.
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