Corticosteroid prescription in children with respiratory symptoms: A real-life study

Abstract

Asthma is one of the most common childhood diseases. Most children respond to low doses of corticosteroids and/or anti-leukotrienes. However, a small percentage remain symptomatic. They require high doses of inhaled corticosteroids (ICS) and anti-leukotrienes, sometimes with long-acting bronchodilators (LABA) and occasionally systemic corticosteroids (SC). However, we frequently observe that the only treatment they receive for exacerbations is short-acting beta-agonists (SABA) and oral corticosteroids (OC) without adding ICS as a maintenance treatment to prevent new episodes. This leads to frequent exacerbations, airflow limitation, and significant alterations in the quality of life. In addition, this results in high resource consumption, frequent emergency room visits, and school absenteeism, leading to absence from work for caregivers. A descriptive, retrospective, observational, and multicenter study was carried out on patients under 12 years of age, who attended pediatric allergy consultations for the first time. The main objective was to determine the consumption of SCs because of respiratory exacerbations in the year before the first consultation. Data were obtained from 144 children, 58.3% male, with a median age of 5 years. It was found that during the year before attending our clinic, 70% had perennial symptoms and were only prescribed with salbutamol on demand when they presented with respiratory symptoms. They had not been prescribed with ICS or anti-leukotrienes. They required attention in the emergency room of their nearest health center or hospital on an average of three times per year. During these exacerbations, almost 75% received SCs(prednisolone), with an average of 2.6 annual cycles (0–12) prescribed in more than half of the cases in the emergency room. In over 80% of the cases, the effects of SC abuse were not previously monitored. The overuse of SC in atopic children with respiratory symptoms was confirmed in our group, which requires considering behavioral changes.