Ricerca
Profilo prescrittivo dei farmaci antiasmatici nella popolazione pediatrica della ASL di Lecco
ANTIASTHMATIC DRUG PRESCRIPTION PROFILE IN A PAEDIATRIC ITALIAN POPULATION
MARINA BIANCHI1, ANTONIO CLAVENNA1, LORENA LABATE1, ANGELA BORTOLOTTI2, IDA FORTINO2, G. WALTER LOCATELLI3, GIANEMILIO GIULIANI3, MAURIZIO BONATI1
1Laboratorio per la Salute Materno-Infantile, IRFMN, Milano
2Servizi Sanitari Territoriali, Assessorato alla Sanità, Regione Lombardia 3ASL di Lecco, Lecco
Dicembre 2007 - pagg. 653 -659
Abstract
Antiasthmatic drugs are often prescribed for conditions different from asthma and many patients
are exposed to therapy for which there is no evidence of efficacy. The aim of this study
was to test whether antiasthmatic drug prescription rates reflect the prevalence of asthma in
an Italian paediatric population, therefore to evaluate appropriateness of treatments. Drug
prescriptions involving 24,407 children <18 years old, dispensed during 2003 by the retail
pharmacies of local health unit of Lecco (Italy), were analysed. Prevalence of antiasthmatic
drug prescription was 11.9% (27.0% of treated). The 56% of children treated with antiasthmatic
received only one box of drug. By subgrouping population ≥ 6 years in low and high
users, we defined two groups at different severity of disease. The analysis of these subpopulations,
using indicators of severity and indicators of appropriateness, suggests the validity of
our approach in differentiating between prevalence of asthma and prevalence of antiasthmatic
prescriptions and confirms the finding that antiasthmatic drugs, in children, are overprescribed.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. SIDRIA (Italian Studies on Respiratory Disorders
in Childhood and the Environment)
Collaborative Group. Asthma and respiratory
symptoms in 6-7 yr old Italian children: gender,
latitude, urbanization and socioeconomic
factors. Eur Respir J 1997;10:1780-6.
2. Galassi C, De Sario M, Biggeri A, et al. Changes in Prevalence of Asthma and Allergies Among Children and Adolescents in Italy: 1994-2002. Pediatrics 2006;117:34-42.
3. Asher MI, Montefort S, Bjorksten B, et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-43.
4. Centers for Disease Control and Prevention/ National Center for Health Statistics. Asthma Prevalence, Health Care Use and Mortality 2003-2005. http://www.cdc.gov/ nchs/products/pubs/pubd/hestats/asthma/ asthma.htm.
5. National Center for Health Statistics. Raw Data from the National Survey of Children’s Health through State and Local Area Intergrated Telephone Survey, 2003.
6. Von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82 (Suppl II):ii2-ii5.
7. World Health Organization (European Health Report 2005). http://www.euro.who. int/document/e87325.pdf.
8. Martinez FD. Development of wheezing disorders and asthma in preschool children. Pediatrics 2002;109:362-7.
9. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
10. National Asthma Education Prevention program. Guidelines for the Diagnosis and Management of Asthma-Update 2002. NIH Publication 02-5075, Bethesda, MD.
11. Global Initiative for Asthma (GINA) 2006; www.ginasthma.com.
12. Clavenna A, Rossi E, Berti A, et al. ARNO Working Group. Inappropriate use of antiasthmatic drugs in the Italian paediatric population. Eur J Clin Pharmacol 2003;59:565-9.
13. Maziak W, von Mutius E, Beimfohr C, et al. The management of childhood asthma in the community. Eur Respir J 2002;20:1476-82.
14. de Vries TW, Tobi H, Schirm E, et al. The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands. Eur J Clin Pharmacol 2006;62:51-5.
15. Cloutier MM, Wakefield DB, Sangeloyty- Higgins P, et al. Asthma guideline use by pediatricians in private practices and asthma morbidity. Pediatrics 2006;118:1880-7.
16. Marchetti F, Longo G. L’uso razionale dei corticosteroidi inalatori: il caso Italia. Medico e Bambino 2006;25:619-20.
17. Kühni CE, Sennhauser FH. The Yentl syndrome in childhood asthma: risk factors for undertreatment in Swiss children. Pediatr Pulmonol 1995;19:156-60.
18. Salpeter SR, Buckley NS, Ormiston TM, et al. Meta-Analysis: Effect of Long-Acting ß- Agonists on severe asthma exacerbations and asthma-related deaths. Ann Int Med 2006;144: 904-12.
19. Lipchik RJ. Addition of salmeterol to usual asthma pharmacotherapy may increase respiratory related deaths or life threatening experiences. Evid Based Med 2006;11:139.
20. Moth G, Vedsted P, Schiotz PO. Identification of asthmatic children using prescription data and diagnosis. Eur J Clin Pharmacol 2007; 63:605-11.
21. Paton J, Jardine E, McNeill E, et al. Adrenal responses to low dose synthetic ACTH (Synacthen) in children receiving high dose inhaled fluticasone. Arch Dis Child 2006;91: 808-13.
2. Galassi C, De Sario M, Biggeri A, et al. Changes in Prevalence of Asthma and Allergies Among Children and Adolescents in Italy: 1994-2002. Pediatrics 2006;117:34-42.
3. Asher MI, Montefort S, Bjorksten B, et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-43.
4. Centers for Disease Control and Prevention/ National Center for Health Statistics. Asthma Prevalence, Health Care Use and Mortality 2003-2005. http://www.cdc.gov/ nchs/products/pubs/pubd/hestats/asthma/ asthma.htm.
5. National Center for Health Statistics. Raw Data from the National Survey of Children’s Health through State and Local Area Intergrated Telephone Survey, 2003.
6. Von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82 (Suppl II):ii2-ii5.
7. World Health Organization (European Health Report 2005). http://www.euro.who. int/document/e87325.pdf.
8. Martinez FD. Development of wheezing disorders and asthma in preschool children. Pediatrics 2002;109:362-7.
9. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
10. National Asthma Education Prevention program. Guidelines for the Diagnosis and Management of Asthma-Update 2002. NIH Publication 02-5075, Bethesda, MD.
11. Global Initiative for Asthma (GINA) 2006; www.ginasthma.com.
12. Clavenna A, Rossi E, Berti A, et al. ARNO Working Group. Inappropriate use of antiasthmatic drugs in the Italian paediatric population. Eur J Clin Pharmacol 2003;59:565-9.
13. Maziak W, von Mutius E, Beimfohr C, et al. The management of childhood asthma in the community. Eur Respir J 2002;20:1476-82.
14. de Vries TW, Tobi H, Schirm E, et al. The gap between evidence-based medicine and daily practice in the management of paediatric asthma. A pharmacy-based population study from The Netherlands. Eur J Clin Pharmacol 2006;62:51-5.
15. Cloutier MM, Wakefield DB, Sangeloyty- Higgins P, et al. Asthma guideline use by pediatricians in private practices and asthma morbidity. Pediatrics 2006;118:1880-7.
16. Marchetti F, Longo G. L’uso razionale dei corticosteroidi inalatori: il caso Italia. Medico e Bambino 2006;25:619-20.
17. Kühni CE, Sennhauser FH. The Yentl syndrome in childhood asthma: risk factors for undertreatment in Swiss children. Pediatr Pulmonol 1995;19:156-60.
18. Salpeter SR, Buckley NS, Ormiston TM, et al. Meta-Analysis: Effect of Long-Acting ß- Agonists on severe asthma exacerbations and asthma-related deaths. Ann Int Med 2006;144: 904-12.
19. Lipchik RJ. Addition of salmeterol to usual asthma pharmacotherapy may increase respiratory related deaths or life threatening experiences. Evid Based Med 2006;11:139.
20. Moth G, Vedsted P, Schiotz PO. Identification of asthmatic children using prescription data and diagnosis. Eur J Clin Pharmacol 2007; 63:605-11.
21. Paton J, Jardine E, McNeill E, et al. Adrenal responses to low dose synthetic ACTH (Synacthen) in children receiving high dose inhaled fluticasone. Arch Dis Child 2006;91: 808-13.
Corrispondenza: bianchi@marionegri.it