Allergy Asthma Immunol Res.  2017 Jan;9(1):52-60. 10.4168/aair.2017.9.1.52.

Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals

• Suh DI
• Yang HJ
• Kim BS
• Shin YH
• Lee SY
• Park G
• Kim WK
• Kim HB
• Baek H
• Kim JK
• Kim JT
• Lim DH
• Asthma Study Group for Preschool Children

• KMID: 2355894
• DOI: http://doi.org/10.4168/aair.2017.9.1.52

Abstract

PURPOSE
Guidelines need to be tailored to where they are applied. We aimed to describe the distinctive asthma severity profile and the pattern of controller prescription in Korean children.
METHODS
Twelve pediatric allergists from tertiary medical centers reviewed medical records of all asthmatic children who visited their clinics between September 1 and November 30 of 2013. Controller prescriptions were re-classified into 4 categories, then the prevalence of each asthma severity category and the controller prescription patterns according to asthma severity assessed by a Western (Global Initiative for Asthma, GINA) and an Asia-Pacific (Japanese Pediatric GuideLine, JPGL) guideline were evaluated.
RESULTS
A total of 840 cases were reviewed. Both GINA and JPGL revealed that 328 (39.0%) and 249 (29.6%) subjects had intermittent asthma whereas 24 (2.9%) and 21 (2.5%) subjects had severe persistent asthma, respectively. Although higher category controllers tended to be prescribed to those who had more severe asthma, there was much overlap in categories of prescribed controllers between groups with regard to asthma severities. Leukotriene receptor antagonists (LTRA) was the most frequently prescribed as a single controller (40%) or as an add-on medication (19%) in the group of asthmatic children <6 years.
CONCLUSIONS
Korean children have distinctive patterns of asthma severity and management strategies with a lower prevalence of severe asthma and a preference toward LTRA rather than low dose inhaled corticosteroids (ICS) alone or add-on long-acting beta-agonist (LABA) in the group of <6 year-old asthmatics that has not been predicted in Western countries. Thus, strategies tailored to regional situations need to be developed and recommended.

Keyword

Asthma; child; guideline; Leukotriene antagonists; Republic of Korea

MeSH Terms

Adrenal Cortex Hormones
Asthma*
Child*
Humans
Leukotriene Antagonists
Medical Records
Prescriptions*
Prevalence
Republic of Korea
Tertiary Care Centers*
Adrenal Cortex Hormones
Leukotriene Antagonists

Figure

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  Fig. 1 Distribution of clues associated with the level of control in 840 asthmatic children.

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  Fig. 2 Distribution of asthma severity in 840 children as categorized by the 2 distinctive asthma guidelines, GINA and JPGL. GINA, Global Initiative for Asthma; JPGL, Japanese Pediatric Guideline.

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  Fig. 3 Prescription patterns of controller medications according to asthma severity assessed using (A) GINA and (B) JPGL. Shaded areas stand for the proportion of LTRA-containing modalities. GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; JPGL, Japanese Pediatric Guideline; LABA, long-acting beta-2 receptor agonist; LTRA, leukotriene receptor antagonist; SABA, short-acting beta-2 receptor agonist.

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  Fig. 4 Prescription patterns of controller medications among different age groups. Shaded areas stand for the proportion of LTRA-containing modalities. GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; JPGL, Japanese Pediatric Guideline; LABA, long-acting beta-2 receptor agonist; LTRA, leukotriene receptor antagonist; SABA, short-acting beta-2 receptor agonist.

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