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Title: Paediatricians Should Reduce Medication in Children With Stable Asthma
URL: http://www.pslgroup.com/dg/22530E.htm
Doctor's Guide
July 7, 2008

BALTIMORE, Md -- July 7, 2008 -- A study of how paediatricians prescribe asthma medications suggests that while most would readily increase a child's medication if needed, many are reluctant to taper off drug use when a child's symptoms are well controlled, according to a study in the July issue of Pediatrics.

"Asthma medications can have serious, albeit infrequent, side effects, and while under-treatment is undeniably a big problem, not stepping down treatment when a child is doing well may be too," said lead investigator Sande Okelo, MD, Johns Hopkins Children's Center, Baltimore, Maryland.

The study was conducted amongst 310 paediatricians nationwide, of which 40% said they would not step down high-dose treatment even if a child's symptoms were well controlled and infrequent.

"If a child is doing well and her symptoms are well under control, why not take that chance and see if a smaller dose would do the trick?" said senior investigator Gregory Diette, MD, Johns Hopkins Children's Center.

Beyond side effects, failure by paediatricians to taper off drugs may also lead parents to do so on their own by skipping doses or decreasing them. "Past research shows that when parents are concerned about side effects and their child is doing well, they may take action without a doctor's approval," said Dr. Okelo.

For the study, the paediatricians were asked to devise treatment plans using different patient scenarios, describing various elements, including whether a child had been hospitalised recently, how bothersome and frequent a child's symptoms were, whether symptoms had recently intensified or lessened, and whether the child had wheezing on a physical exam.

Most physicians reported they would step-up treatment in patients with recent hospitalisations, frequent symptoms, when parents said they were bothered by their child's symptoms, and those who had wheezing on exam.

While current treatment guidelines focus on symptom frequency, nearly all paediatricians reported using multiple factors in their decision-making, including quality of life and how bothered parents were by their child's symptoms.

Dr. Okelo says paediatricians might greatly benefit from a step-by-step, "frontlines" tool that tells them how to specifically apply treatment guidelines and how to use different dimensions of the disease in their day-to-day practice.


SOURCE: Johns Hopkins Medical Institutions

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