Inhaled corticosteroids for recurrent respiratory symptoms in preschool children in general practice: Randomized controlled trial

Schokker, Siebrig; Kooi, Elisabeth M. W.; Vries, Tjalling W. de; Brand, Paul; Mulder, Paul; Duiverman, Eric J.; Molen, Thys van der

doi:10.1016/j.pupt.2006.12.007

Cited by 25 publications

(13 citation statements)

References 31 publications

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“…All consultations, with the reasons for the encounter as well as the diagnosis and the prescriptions, are registered. Morbidity data are electronically recorded using the International Classification of Primary Care (ICPC) 16 and each prescribed medication is provided with an ICPC-based indication. The prescriptions are automatically classified with an Anatomical Therapeutical Chemical (ATC) code.…”

Section: Methodsmentioning

confidence: 99%

“…9,12,13 On the other hand, studies including a more heterogeneous population, such as children from primary care, showed no beneficial effect of ICS. 14,15 The key issue seems to be diagnostic uncertainty, and the resulting uncertainty regarding the optimal treatment of these children. Since time is the only factor which can teach us more about the outcome of respiratory symptoms in early childhood, studies using longitudinal data offer a unique opportunity to explore the diagnostic and therapeutic issues in children with asthma or asthma-like symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Prescribing of asthma medication in primary care for children aged under 10

Schokker

Groenhof

Veen

et al. 2009

Primary Care Respiratory Journal

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Objective: To evaluate prescriptions of asthma medication for children in primary care.Methods: Data on prescriptions of asthma medication for children aged 0-9 years were collected from a general practice-based network in the north eastern part of the Netherlands. Prevalence, incidence, indications, continuation beyond the age of 6 years, and predictors of continuation, were determined.Results: Prevalence of prescriptions was about 80 per 1000 person years. An asthma diagnosis was registered in 40% of the children with a first prescription and in 70% of the children with six or more prescriptions. Discontinuation of asthma medication was between 60 and 90%. Continuation was more likely in children with a first prescription at age 2 or 3 as compared to children starting treatment at age ≤1 year. Children with prescriptions for β2-agonists and inhaled corticosteroids were more likely to continue treatment than children with β2-agonist monotherapy prescriptions. Conclusion:Continuation of asthma medication in children is low. Age at first prescription and the type of asthma medication are predictors of continuation of asthma medication from preschool into school-age.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prescribing of asthma medication in primary care for children aged under 10

Schokker

Groenhof

Veen

et al. 2009

Primary Care Respiratory Journal

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“…In a post hoc analysis of two large randomised controlled trials in young children (aged 12-47 months), those with frequent symptoms, aged .2 yrs and/or with a family history of asthma showed the best response to treatment with fluticasone (200 mg?day -1 ), whereas those with less frequent symptoms, without a family history of asthma and aged ,2 yrs showed no significant treatment effect [111]. Two recent studies using inhaled fluticasone to treat wheezy infants and preschool children failed to find any improvement in lung function [112,113]. Atopic markers, such as a history of atopic dermatitis or allergic rhinitis, did not improve the chance of responding to ICSs [111].…”

Section: Inhaled Corticosteroidsmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

European Respiratory Journal

735

753

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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“…The very few studies on effects of inhaled corticosteroids in preschool children in primary care have shown no effect; 14 …”

Section: O P Y R I G H T G E N E R a L P R A C T I C E A I R W A Y mentioning

confidence: 99%

New guidelines on recurrent wheeze in preschool children: implications for primary care

Brand

2008

Primary Care Respiratory Journal

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Inhaled corticosteroids for recurrent respiratory symptoms in preschool children in general practice: Randomized controlled trial

Cited by 25 publications

References 31 publications

Prescribing of asthma medication in primary care for children aged under 10

Prescribing of asthma medication in primary care for children aged under 10

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

New guidelines on recurrent wheeze in preschool children: implications for primary care

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