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Child asthma guidance not reflected in practice



By Lilian Anekwe

GP prescribing practices when managing children and young teenagers with asthma ‘does not always correspond to recommendations of asthma management guidelines’ according to a UK observational study.

A study of 10,000 children 14 and under with asthma or recurrent wheezing recorded in the General Practice Research Database between September 2006 and February 2007 found that 91% had a prescription for an inhaled steroid – as recommended by guidance.

But 1.5% of under fives and 3.2%% of children aged 5-14 were prescribed high doses of ICS alone at doses of up to 800mcg a day – a dose for which the drug is not licensed – during the previous six months

Combination inhaled steroid-LABA therapy was prescribed for 7% of patients, most of whom were classified as having intermittent or mild persistent asthma. Of children with severe asthma, none were prescribed additional therapy.

Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire and a hospital practitioner in asthma, led the study and concluded: ‘Physician classifications of asthma severity did not always correspond to guideline recommendations, as leukotriene receptor antagonists were rarely used and high-dose inhaled steroid or add-on LABA was prescribed, even in intermittent and mild disease.’

BMC Pulmonary Medicine 2010, 10:29

Child asthma guidance not reflected in practice