Adherence to guidelines for drug treatment of asthma in children: potential for improvement in Swedish primary care.

BACKGROUND: Adherence to guidelines in general is poor. Because asthma is the most common chronic disease in Swedish children, identifying areas for improvement regarding drug treatment for asthma is crucial. AIM: To explore the utilisation patterns of anti-asthmatic drugs in children with asthma in relation to evidence-based guidelines. METHOD: All children visiting 14 primary healthcare centres in Stockholm, Sweden, who had their first prescription of anti-asthmatic agents dispensed between July 2006 and June 2007 were followed over 24 consecutive months. The children (1033 in total) were divided in two age groups: 0-6 years and 7-16 years. The outcome measurements were: the characteristics of the physicians initiating drug treatment; the extent to which the children were initiated on the drugs recommended in the guidelines; and the amount and frequency of drugs dispensed over time and whether the dosage texts on the prescriptions contained adequate information. RESULTS: In 54% of the older children and 35% of the younger children, only one prescription for anti-asthmatic drugs was dispensed during two years of follow-up following the first prescription. In school-aged children, 50% were initiated on inhaled short-acting bronchodilating beta2-agonists (SABA) in monotherapy. Among preschool children, 64% were initiated on SABA and inhaled corticosteroids in combination. In 41% of the prescriptions dispensed, the indication was stated and in 25% the mechanism of action was stated. Drug therapy was initiated by a general practitioner in 42% of the younger children and 72% of the older children. CONCLUSION: There is a need for improvement in adherence to guidelines in important areas. Asthma, especially among children aged 7-16 years, is usually a chronic disease and should, in many cases, be treated with anti-asthmatics counteracting inflammation. However, this was not the case in our study. In addition, the dosage texts written by the physicians did not follow recommendations and may negatively influence patient safety.