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Published on 7 July 2008

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Taper medications in childhood asthma

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A study of how paediatricians prescribe asthma medications suggests that while most would readily increase a child’s medication if needed, many are reluctant to taper off drug use when less might be best.

A report on the study, led by researchers at the Johns Hopkins Children’s Center, USA, appears in the July issue of Pediatrics.
“Asthma medications can have serious, albeit infrequent, side-effects,” said lead investigator Sande Okelo MD. “And while under-treatment is undeniably a big problem, not stepping down treatment when a child is doing well may be too.”

In the research, conducted among 310 paediatricians across the USA, 40% said they would not step down high-dose treatment even if a child’s symptoms were well controlled and infrequent.

Beyond side-effects, Okelo says, a failure by paediatricians to taper off drugs may also lead parents to do so on their own by skipping doses or decreasing them.

“Past research shows that when parents are concerned about side-effects and their child is doing well, they may take action without a doctor’s approval,” Okelo says.

For the study, the paediatricians were asked to devise treatment plans using different patient scenarios, describing various elements, including whether a child had been hospitalised recently, how bothersome and frequent a child’s symptoms were, whether symptoms had recently intensified or lessened, and whether the child had wheezing on a physical exam. Most doctors reported they would step up treatment in patients with recent hospitalisations, frequent symptoms, parents who said they were bothered by their child’s symptoms, and in those who had wheezing on exam.

While current treatment guidelines focus on symptom frequency, nearly all paediatricians reported using multiple factors in their decision making, including quality of life and how bothered parents were by their child’s symptoms.

Okelo says paediatricians might greatly benefit from a step-by-step, “frontline” tool that tells them how to specifically apply treatment guidelines and how to use different dimensions of the disease in their day-to-day practice.

Because asthma is an unstable disease and can change often and unpredictably, it is essential that children with asthma get regular follow-up exams every three to six months even in the absence of symptoms, researchers recommend.

Johns Hopkins Children’s Center



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