Variations in the treatment of childhood asthma.

OBJECTIVE

To survey the assessment and management of childhood asthma by paediatricians, general practitioners, and respiratory physicians, and compare these findings with the Australian and New Zealand Consensus Statement guidelines on asthma management in children.

SETTING AND DESIGN

A six-item postal questionnaire designed to cover assessment, management of acute and mild asthma, use of prophylaxis and methods of delivery of medication.

PARTICIPANTS

A random sample of 100 paediatricians, 300 general practitioners and 100 respiratory physicians.

RESULTS

Response rates were: paediatricians, 88%; general practitioners, 66%; and respiratory physicians 51%. There was agreement between all three groups in most aspects of asthma management. Deviations from the Consensus Statement guidelines included: between 38% and 49% not using oxygen as one of the first-line treatments for acute asthma; a higher use of orally administered beta 2-agonists by general practitioners (up to 40% for children between one and three years compared with 17% of paediatricians and 12% of respiratory physicians); a tendency to use intravenously administered aminophylline before corticosteroids (20% of paediatricians, 40% of general practitioners and 30% of respiratory physicians); a preference among general practitioners and respiratory physicians to prescribe inhaled corticosteroids rather than sodium cromoglycate for prophylaxis in older children; and a low incidence of use of spacer devices in older children.

CONCLUSIONS

If currently published recommendations on managing asthma in children are followed, there should be: more education and emphasis on the value of oxygen and short courses of orally administered corticosteroids in acute asthma management; less reliance on intravenously administered aminophylline; decreased use of orally administered beta 2-agonists coupled with a more wide-spread use of spacer devices; and an increased emphasis on sodium cromoglycate as first-line daily prophylaxis.