ABSTRACT
Background@#Bronchial asthma is one of the most common chronic childhood diseases encountered in the primary care setting. Adherence to recommendations from clinical practice guidelines on asthma can be utilized as an indicator of quality of care when evaluating the implementation of the universal health care in the Philippines.@*Objectives@#To determine the clinical profile of pediatric patients with bronchial asthma; and to evaluate the prescription patterns for asthma treatment in a primary care setting.@*Methods@#This was a retrospective cohort study that involved review of the electronic medical records in a rural site of the Philippine Primary Care Studies (PPCS). All patients less than 19 years old who were diagnosed with asthma from April 2019 to March 2021 were included. Quality indicators for asthma care were based on adherence to recommendations from the 2019 Global Initiative for Asthma (GINA) Guidelines.@*Results@#This study included 240 asthmatic children with mean age of 6 years (SD ± 4.9) and a slight male preponderance (55.4%). Majority (138 children or 57.5%) were less than 6 years old. Out of the 240 children, 224 (93.3%) were prescribed inhaled short-acting beta-agonists (SABA) and 66 (27.5%) were prescribed oral SABA. Only 14 children (5.8%) were prescribed inhaled corticosteroids (ICS), with 13 children (5.4%) given ICS with longacting beta-agonists (LABA) preparations, and one child (0.4%) given ICS alone. Quality indicators used in this study revealed underutilization of ICS treatment across all age groups, and an overuse of SABA-only treatment in children 6 years old and above. Moreover, 71.3% of the total patients were prescribed antibiotics despite the current GINA recommendation of prescribing antibiotics only for patients with strong evidence of lung infection, such as fever or radiographic evidence of pneumonia.@*Conclusion@#There were 240 children diagnosed with asthma over a 2-year period in a rural community, with a mean age of 6 years old and a slight male predominance. This quality-of-care study noted suboptimal adherence of rural health physicians to the treatment recommendations of the GINA guidelines, with overuse of SABA and underuse of ICS for asthma control.
Subject(s)
AsthmaABSTRACT
@#<p style="text-align: justify;"><strong>Background.</strong> Previous studies show that Vitamin D has an inverse relationship with asthma severity, symptoms, exacerbations, medication usage, and a direct relationship with lung function. IL-17A was found to be increased in asthmatics, which was inhibited by Vitamin D. Associations found between vitamin D, IL-17A, and asthma may support the future role of vitamin D in the treatment of asthma in children.</p><p style="text-align: justify;"><strong>Objective.</strong> To compare vitamin D and IL-17A levels between children with and without asthma and determine their association with asthma severity</p><p style="text-align: justify;"><strong>Study Design.</strong> Cross-sectional study</p><p style="text-align: justify;"><strong>Methods.</strong> There were 44 participants, aged 3 to 18 years: 22 with asthma (12 non-severe, 10 severe) and 22 without asthma. Participants with any disease-altering vitamin D metabolism, intake of vitamin D supplementation, and recent infection were excluded. Serum vitamin D and IL-17A levels were measured in all participants.</p><p style="text-align: justify;"><strong>Results.</strong> There was no significant difference in mean vitamin D levels between participants with asthma (29.6 ± 12.6 ng/mL) and without asthma (27.6 ± 9.5 ng/mL) (p = 0.55) as well as between participants with non-severe asthma (29.8 ± 14.0 ng/mL) and severe asthma (29.4 ± 11.5 ng/mL) (p = 0.95). The overall prevalence of hypovitaminosis D (< 30ng/mL) is 61.4%; 59.1% among those with asthma and 63.6% without asthma. The prevalence of vitamin D insufficiency and/or deficiency did not significantly differ between those with and without asthma (all p-value > 0.05); prevalence ratios were: 1.05 for vitamin D insufficiency, 0.58 for vitamin deficiency, and 0.92 for vitamin D insufficiency and deficiency combined. There was also no significant difference in the prevalence of vitamin D insufficiency and/or deficiency between severe and non-severe asthma (all p-values > 0.05), with prevalence ratios: 0.74 for vitamin D insufficiency, 0.50 for vitamin D deficiency, and 0.75 for vitamin D insufficiency and deficiency combined. Serum IL-17A levels were below the minimum detectable levels in 96% of the participants using the MILLIPLEX Map Human TH17 Magnetic Band Panel; hence, could not be analyzed.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The mean serum vitamin D levels do not differ between children with asthma and healthy controls. There was no significant relationship between mean vitamin D levels and asthma severity. There was no association between the prevalence of vitamin D insufficiency and/or deficiency and asthma and its severity. The overall prevalence of hypovitaminosis D in this study is 61.4%. Serum IL-17A levels were undetectable in 96% of the study population.</p>