A multicenter survey of childhood asthma in Turkey – II: Utilization of asthma drugs, control levels and their determinants

Authors


  • Contributors:
    Soyer OU participated in the development of the protocol and analytic framework of the study, had primary responsibility for data analysis, had primary responsibility for patient screening in her study center and prepared the manuscript with BE Sekerel.

    Beyhun NE participated in the development of the protocol and analytic framework of the study, contributed to preparation of the manuscript.

    Demir E, Yıldırım S, Bingöl Boz A, Altınel N, Cevit O, Karakaş T, Anlar Y, Söğüt A, Altıntaş D, Canıtez Y, Büyükdereli Z supervised the design and execution of the study, contributed to preparation of the manuscript, and had primary responsibility for patient screening in their study centers.

B. E. Sekerel, MD, Department of Pediatrics, Hacettepe University Faculty of Medicine, Pediatric Allergy and Asthma Unit, 06100 Ankara, Turkey
Tel.: +90-312-324 2511
Fax: +90-312-311 2357
E-mail: b_sekerel@yahoo.com

Abstract

Many surveys worldwide have consistently demonstrated a low level of asthma control and under-utilization of preventive asthma drugs. However, these studies have been frequently criticized for using population-based samples, which include many patients with no or irregular follow-ups. Our aim, in this study, was to define the extent of asthma drug utilization, control levels, and their determinants among children with asthma attending to pediatric asthma centers in Turkey. Asthmatic children (age range: 6–18 yr) with at least 1-yr follow-up seen at 12 asthma outpatient clinics during a 1-month period with scheduled or unscheduled visits were included and were surveyed with a questionnaire-guided interview. Files from the previous year were evaluated retrospectively to document control levels and their determinants. From 618 children allocated, most were mild asthmatics (85.6%). Almost 30% and 15% of children reported current use of emergency service and hospitalization, respectively; and 51.4% and 53.1% of children with persistent and intermittent disease, respectively, were on daily preventive therapy, including inhaled corticosteroids. Disease severity [odds ratio: 12.6 (95% confidence intervals: 5.3–29.8)], hospitalization within the last year [3.4 (1.4–8.2)], no use of inhaled steroids [2.9 (1.1– 7.3)], and female gender [2.3 (1.1–5.4)] were major predictors of poor asthma control as defined by their physicians. In this national pediatric asthma study, we found a low level of disease control and discrepancies between preventive drug usage and disease severity, which shows that the expectations of guidelines have not been met even in facilitated centers, thus indicating the need to revise the severity-based approach of asthma guidelines. Efforts to implement the control-based approach of new guidelines (Global Initiative for Asthma 2006) would be worthwhile.

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