Changing Trends in the Treatment of Asthma in a Tertiary Canadian Pediatric Hospital

Abstract

During the last few years there has been a major change in the perception of childhood asthma management, with more focus on the anti-inflammatory aspects of therapy, the use of inhaled ipratroprium bromide, and decreased home usage of theophylline. Our clinical impression that the management of asthma at our institution has altered in response to these trends prompted us to review our experience with childhood asthma. A random sample of approximately 70 cases was reviewed from admissions to The Hospital for Sick Children during the first 6 months of 1987 and 1990. There was a major reduction in theophylline usage in 1990 accompanied by increased use of ipratroprium and oral corticosteroids. Significantly fewer cases of potentially toxic theophylline serum levels were observed in 1990, suggesting increased awareness of the this drug's narrow therapeutic margin of safety. In 1990, patients tended to be pyrexial and were treated with antibiotics more often. They were also younger, which may explain the higher pulse and respiratory rates observed. Despite these trends toward younger, sicker patients being admitted to the hospital, the length of stay did not increase, and similar numbers needed intensive care. This suggests that the shift in therapeutic modality did not affect hospitalized asthmatic children adversely.

Antibiotic Treatment of Wheezing in Children With Asthma: What Is the Practice?

“…12 The same extent of antibiotic use in children with asthma has been observed in other settings. [4][5][6][7][8]14 We identified several physician characteristics in which this inappropriate prescribing occurred more often. Namely, GPs were more likely than pediatricians to prescribe an antibiotic for a wheezing episode, as were older physicians.…”

“…3 Despite this evidence, it is estimated that 15% to 25% of children receive antibiotics for episodes of wheezing or asthma. [4][5][6][7][8] Similar to the general trend in antibiotic use among children, antibiotics were used increasingly more often to treat acute asthma in the North American setting in the late 1980s. 8,9 The 1990s witnessed a reversal of the trend in overall antibiotic use.…”

“…[4][5][6][7][8] Similar to the general trend in antibiotic use among children, antibiotics were used increasingly more often to treat acute asthma in the North American setting in the late 1980s. 8,9 The 1990s witnessed a reversal of the trend in overall antibiotic use. 10,11 However, antibiotic resistance has increased, and certain environments, such as child care centers, have been identified as reservoirs of antibiotic resistance.…”

Drug Therapy Approaches in the Treatment of Acute Severe Asthma in Hospitalised Children

“…[128][129][130][131][132][133][134] Adverse effects occur more frequently when theophylline is used, and theophylline serum concentration monitoring contributes to the cost of care. With the availability of effective and relatively safe aerosol treatments of acute, severe asthma, intravenous aminophylline use should be reserved for children who respond poorly or fail to improve on maximal β-agonist therapy.…”