Asthma symptoms and medication in the PIAMA birth cohort: Evidence for under and overtreatment

Authors

  • Daan Caudri,

    1. Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
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  • Alet H. Wijga,

    1. Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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  • Henriette A. Smit,

    1. Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
    2. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • Gerard H. Koppelman,

    1. Department of Pediatric Pulmonology and Pediatric Allergology Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, The Netherlands
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  • Marjan Kerkhof,

    1. Department of Epidemiology, University Medical Centre Groningen, University of Groningen, The Netherlands
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  • Maarten O. Hoekstra,

    1. Centre for Paediatric Allergology, University Medical Centre St Radboud, Nijmegen, The Netherlands
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  • Bert Brunekreef,

    1. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
    2. Institute for Risk Assessment Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • Johan C. de Jongste

    1. Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
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Professor Dr Johan C. de Jongste, Erasmus MC/Sophia Children’s Hospital, Department of Pediatric Respiratory Medicine, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
Tel.: + +31 10 463 6263
Fax: + +31 10 463 6811
E-mail: j.c.dejongste@erasmusmc.nl

Abstract

To cite this article: Caudri D, Wijga AH, Smit HA, Koppelman GH, Kerkhof M, Hoekstra MO, Brunekreef B, de Jongste JC. Asthma symptoms and medication in the PIAMA birth cohort: Evidence for under and overtreatment. Pediatric Allergy Immunology 2011; 22: 652–659.

Abstract

Objective:  Under and overtreatment of asthma may be a serious problem especially in young children, but the evidence is scarce and no longitudinal data are available. Our aim was to investigate whether inhaled medication use in young children was in agreement with asthma symptoms at the age of 2–8 yr.

Methods:  Data were used from the ‘Prevention and Incidence of Asthma and Mite Allergy’ birth cohort, consisting of 3963 children born in the Netherlands. Between age 2 and 8 yr, children were followed up using annual postal questionnaires. Age-specific prevalences of asthma symptoms were assessed and compared with reported use of inhaled bronchodilators and/or corticosteroids.

Results:  The proportion of current wheeze decreased with age. About a third of ‘current wheezers’ did not use any inhaled medication during the years in which symptoms were reported. At 8 yr, 30% of children with reported ‘severe current asthma symptoms’ were not using inhaled corticosteroids. On the other hand, up to 50% of children with inhaled corticosteroids for at least 2 yr did not report any wheezing during those 2 yr.

Conclusion:  The proportion of symptomatic children without appropriate treatment was substantial throughout childhood, even when parents reported prolonged or severe symptoms. Treatment of asymptomatic children with inhaled corticosteroids increased with age and accounted for up to a third of all inhaled steroid use at 8 yr. These findings suggest that under and overtreatment of asthma in children was common.

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