Pharmacological management of children's asthma in general practice: Findings from a community-based cross-sectional survey in Auckland, New Zealand

Abstract

AIM: To describe the pharmacological management of children's asthma and to assess whether there were ethnic differences in pharmacological management. METHODS: A community-based, cross-sectional, interviewer administered face-to-face survey. The sample (n=583) included the caregivers of 221 Māori, 173 Pacific, and 189 European/other children. Data collected included sociodemographic information, and medications received and medication delivery devices used in the 12 months prior to interview. Descriptive and logistic regression analyses to investigate ethnic differences in pharmacologic management were undertaken. RESULTS: Spacer devices were used by 80% of children under 7 years of age and 34% of children 7 years or over. No ethnic differences in the use of these devices were observed. Māori (58%) and Pacific (65%) were significantly (p<0.0001) more likely to have been given a nebuliser (European/other 34%). Most (96%) children received inhaled beta-agonists and there were no ethnic differences for these medications. Overall, 69% of children had received inhaled corticosteroids (ICS) and there were no significant ethnic differences in receipt of these medications. However, only 68-78% of children in the moderate, severe, and very severe morbidity groups reported inhaled corticosteroids use in the previous 12 months, suggesting that this group is being under-treated. Morbidity stratified analyses suggested that Māori and Pacific children who had experienced severe morbidity in the previous 12 months were less likely to have received ICS. CONCLUSIONS: Some aspects of the pharmacological management of asthma are more consistent with recommendations in evidence-based guidelines than previously reported in NZ. The proportion of children with asthma who were receiving beta agonists and ICS were higher than that previously reported in NZ and the reported use of anticholinergics was low. However, other findings show there is still room for further improvements to be made, particularly with respect to the use of inhaled corticosteroids among children who experience significant morbidity, the use of nebulisers, and the use of spacer devices. The implementation of clinical quality assurance activities that support primary health organisations and providers to monitor and improve the delivery of evidence-based asthma care could further improve asthma outcomes.