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Original article
Spirometry monitoring in asthmatic children in Lombardy Region, Italy
  1. Pietro Casartelli1,2,
  2. Antonio Clavenna1,
  3. Massimo Cartabia1,
  4. Angela Bortolotti3,
  5. Ida Fortino3,
  6. Luca Merlino3,
  7. Andrea Biondi2,
  8. Maurizio Bonati1
  1. 1 Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
  2. 2 Department of Pediatrics, Hospital S Gerardo/Fondazione MBBM, University of Milano-Bicocca, Monza, Italy
  3. 3 Regional Health Ministry, Lombardy Region, Milan, Italy
  1. Correspondence to Dr Antonio Clavenna; antonio.clavenna{at}marionegri.it

Abstract

Objectives To evaluate the diagnostic and therapeutic approaches in a cohort of asthmatic children before and after starting drug therapy.

Methods Data were retrieved from administrative databases of the Lombardy Region. The study population was composed of 78 184 children born in the Lombardy Region in 2002 and followed until their 10th birthday.

Children with at least one antiasthmatic drug prescription per year (with the exclusion of nebulised suspension/solution formulations) in 2 consecutive years and at least one antiasthmatic drug prescription after the fifth birthday were identified as potential asthmatics (PA).

Each PA was monitored for a period starting from 12 months before and ending 24 months after the first prescription (index prescription, IP). During the monitoring period antiasthmatic drug prescriptions were analysed, as well as spirometry and/or specialist visits.

Results A total of 59 975 children (76.7%) received ≥1 prescription of antiasthmatic drugs in their first 10 years of life, and 4475 (5.7%) were identified as PAs. In all, 24% of PAs started with short-acting β2-agonists (SABA), 23% with inhaled corticosteroids (ICS) and 20% with SABA+ICS.

A total of 33% of PAs had at least one prescription for specialist visit/spirometry: 11% before and 28% after the IP. The factors associated with a greater likelihood of receiving visit/spirometry prescriptions were local health unit of residence, age and high use of asthma drugs.

Conclusions Despite international guideline recommendations, spirometry monitoring is still underused in asthmatic children, even in subjects who initiated pharmacological treatment and therefore need an airway function evaluation. Moreover, the choice of drug therapy appears not always rational, since one out of four children were commenced on ICS as monotherapy.

  • asthma
  • child
  • drug therapy
  • epidemiology
  • spirometry

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Footnotes

  • Contributors PC was involved in planning the study, in data management, and drafted the initial manuscript. AC conceptualised, designed and supervised the study. MC carried out the statistical analyses. ABo and IF were involved in the data management. LM and ABi were involved in study design. ABi and MB contributed to defining the protocol, and supervised the study. All the authors reviewed and revised the manuscript, and approved the final manuscript as submitted.

  • Funding The study was funded by the Lombardy Region (EPIFARM Project).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval No ethics committee approval is required in Italy for epidemiological studies using healthcare administrative databases for research purposes and with individuals identified by an anonymous patient code.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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