Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?

Abstract

Aim: The aim of the present study was to investigate the characteristics of hospital admissions in two child populations receiving different types of drugs as their regular medication for steady‐state asthma. Methods: Annual data on children aged under 16 y treated for asthma, including consumption of regular medication for asthma, numbers of hospital periods, lengths of hospitalizations and annual proportions of readmissions, were collected using patient‐specific medical records from 1995 to 1999. In the Kuopio province, on average, 35.6–36.7/1000 children were on maintenance for asthma, of which 23% were receiving cromones, 51% were taking inhaled steroids and 26% were treated with cromones plus intermittent steroids. In the Oulu province, the respective prevalence was 32.7–34.9/1000, and the respective proportions were 5%, 93% and 2%. Results: Total and first admissions, as well as hospital days were clearly less in the Oulu province. In the children aged ≥6 y, the average annual total admissions were 0.3/1000 (Oulu) vs 1.2/1000 (Kuopio) (p < 0.001). Similarly, the first admissions were 0.2/1000 vs 1.0/1000 (p < 0.001), proportions of readmissions 6.3% vs 19.3% (p < 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p < 0.001). The differences were in the same direction, though less prominent, also among children 2–5 y of age. Conclusion: Our results suggest that inhaled steroids are better than cromones in preventing admissions for asthma when two provinces with different practices for maintenance medication of steady‐state asthma were compared.

Use of inhaled corticosteroids decreases hospital admissions for asthma in young children

“…In line with studies made in older children, [1,6,7,9] readmissions were less frequent in the area where maintenance therapy in young children was more active. In the present study in children less than 2 years old, active use of ICSs was observed in the Kuopio area, opposite to the previous fi ndings in older children [9] (Table 3). Thus, the different admission rates between these two hospitals indicate more probably differences in maintenance therapy than those in hospitalization practice.…”

“…[1,4,5] In particular, this improved asthma control has decreased the risk of repeated hospital admissions. [6][7][8] In our previous study in over 2-year-old children with asthma, hospitalizations were less common in the Oulu area where ICSs were in active use for asthma, compared with the Kuopio area with a step-wise use of cromones and ICSs [9] (Table 3). On the other hand, hospitalizations reveal only the top of the iceberg, and the true burden caused by mild asthma in the child population is unknown.…”

“…In addition, the study in older children aged more than 2 years was done at the same time in the same two populations with the same potential confounding factors, and the hospitalization fi gures for asthma (lower in Oulu) were associated with the use of ICSs (higher in Oulu), not the area itself. [9] Since asthma in young children is often diagnosed in hospital during admissions for the recurrence of wheezing, fi rst admissions due to wheezing refl ect the number of individuals at asthma risk in the population. Simultaneously with the decrease in hospitalizations for asthma, hospitalization rates of infants and young children for bronchitis with wheezing have been high.…”

“…[9] The main principle was that there is a need for in-patient care if the obstruction does not improve after two doses of nebulized salbutamol given 30 minutes apart at the out-patient clinic. Salbutamol was given by a jet nebulizer (Spira ® , Spira Respiratory Care Unit Ltd, Hämeenlinna, Finland) at a dose of 0.15 mg/kg in Kuopio and of 0.075 mg/kg in Oulu.…”

“…[6][7][8] In our recent study in children with asthma aged more than 2 years, hospital admissions and especially readmissions were associated with the use of ICSs at the population level. [9] Corresponding data are not available in young children, who often suffer, despite fulfi lled asthma criteria and settled asthma diagnoses, from virus-induced periodical and transient wheezing.…”