Differences in asthma diagnosis and medication use in children living in Germany and the Netherlands

Abstract

Aim:To compare diagnosis and treatment between German and Dutch children with asthmatic symptoms at the age of 5-6 and 7-8 years, and the use of anti-asthma medication at 7-8 years of age. Methods: Parents of 4462 children participated in two surveys, in 1995 and 1997. All 465 children identified with current asthmatic symptoms at the age of 5-6 (May 1995) or at 7-8 years of age (May 1997) were sent a third more detailed questionnaire (October 1997). Results: Asthma diagnosis was more prevalent in Dutch children with current asthmatic complaints (50-60%), whereas over 90% of the German children with current asthmatic complaints had been diagnosed with bronchitis. Inhaled ␤ 2 -agonists were more frequently used by Dutch children compared to German children (67.3% vs. 45.6% p < 0.01) as were inhaled steroids (38.9% vs. 7.0% p < 0.01). Instead, German children more often used sodium cromoglycate or nedocromil as anti-inflammatory medication as compared with Dutch children (42.1% vs. 11.5% p < 0.01). Conclusions: Differences in diagnosis rates for asthma and bronchitis between German and Dutch children most likely result from differential labelling of complaints, and probably lead to differences in treatment practice, indicating possible undertreatment of German children with inhaled steroids.

Variations in the prevalence of childhood asthma and wheeze in MeDALL cohorts in Europe

“…in Italy [ 15 ], and evidence of overdiagnosis in the Netherlands [ 16 ]. One study found that asthmatic complaints which often led to an asthma diagnosis for children in the Netherlands were frequently diagnosed and treated as bronchitis in Germany [ 17 ]. These differences in healthcare may contribute to some of the variation in prevalence rates of asthma and wheeze with diagnosed asthma found in our study.…”

Diagnosing asthma in adults in primary care: a qualitative study of Australian GPs' experiences

“…The findings reported here about the problem of failure to re-attend for follow-up are consistent with findings from an evaluation of the Australian Asthma 3+ management program where patients often failed to complete the third follow-up visit with their GP within the specified time period. 16 The GPs attending these focus groups were not confident about the use of spirometry and few had a practice nurse to help them with this task. The role of the practice nurse in Australia is less developed than in other countries 17 and many have not undertaken post-registration training in respiratory care and may not be confident with spirometry.…”

“…Furthermore, there were clear differences in the labelling of children with current symptoms of asthma in a study in the German Dutch border area; the Dutch children tended to be labelled as asthmatic and the German children tended to be labelled as having bronchitis. 15 Although there may be some reservations about the criteria used to define the diagnosis of asthma in these studies, it is clear that there is substantial variation in the use of this diagnostic label in many different settings.…”

What's in this issue?

“…This study provides further evidence that unnecessary delays occur in diagnosing asthma, probably related to inconsistent terminology and understanding of respiratory symptoms by both patients and health professionals. Similarly, a large survey [13] published in this issue involving interviews of over 4000 parents comparing diagnosis and treatment in German and Dutch children with asthmatic symptoms, found significant differences in approaches to diagnostic labelling between the two countries. Østergaard [12] suggests that we should be more rigorous in diagnosing asthma, especially if children present to a health professional with three or more episodes of asthma symptoms (cough, wheeze or shortness of breath) lasting over two weeks.…”