Diagnosing a child as being asthmatic does not drive prescribing of asthma medication.

Zuidgeest, M.G., Bracke, M., Smit, H.A., Dijk, L. van, Brunekreef, B., Leufkens, H.G. Diagnosing a child as being asthmatic does not drive prescribing of asthma medication. American Journal of Respiratory and Critical Care Medicine: 2007, 175(suppl.), p. A85. Abstract. Annual meeting of the American Thoracic Society, San Francisco, 18-23 mei 2007.
Introduction: Despite the existence of guidelines, studies describing use of asthma medication in children show ample variability and raise concern about both over- and under treatment. Our aim was to study which factors drive the process of prescribing asthma medication for children. The first factor to be investigated was doctor-diagnosed asthma. Methods: We studied all 86,859 children below 18 years of age, belonging to 95 GP practices within the second Dutch national survey of general practice, in which GPs registered all physician-patient contacts in 2001. For children who received a prescription for asthma medication we determined whether they had doctor-diagnosed asthma, coded according to the International Classification of Primary Care. Results: Of all children receiving asthma medication (8.1% of study population) only 48% had doctor-diagnosed asthma, varying from 37% to 56% within different age groups. Subgroup analysis showed that children receiving either ß2-agonists or inhaled corticosteroids were less often diagnosed with asthma than the ones using a combination of these drugs (36% and 41%, respectively, compared to 64%). Conclusions: We clearly show that the decision to prescribe asthma medication is not solely driven by an asthma diagnosis. More so, less then 50% of children using asthma medication had doctor-diagnosed asthma. And even in specific subgroups, e.g. children using combination therapy, a diagnosis was present in at most 64%. This discrepancy existed not only in young children where diagnostic problems are present, but in all age groups. From these results it is clear that we need to investigate which other factors drive prescribing of asthma medication. (aut. ref.)