Astma bij jonge kinderen: verschillen in therapie tussen huisartsen en kinderartsen, en beloop van klachten in i-2,5 jaar

To compare the therapeutic approaches to asthmatic symptoms in young children of general practitioners and paediatric pulmonologists, and to investigate the outcome of asthma in young children. Retrospective, descriptive. Paediatric pulmonology outpatient clinic, University Hospital, Groningen, the Netherlands. Charts of all 91 children younger than 2 years of age who were newly referred for recurrent cough and wheeze (asthma) between January 1, 1994, and September 30, 1995, were reviewed. Data were collected on clinical characteristics, drugs prescribed by the general practitioners, results of laboratory tests, and treatment prescribed by the paediatric pulmonologists. All children were followed up for periods of 12 to 30 months. Sixty-one children (67%) had been treated with antibiotics or with oral anti-asthma drugs by their general practitioners. No child had a positive radioallergosorbent test for inhaled allergens. Paediatric pulmonologists most commonly prescribed inhaled corticosteroids and bronchodilators to these patients. After 12-30 months of follow-up, 48 patients (53%) had no further symptoms. The only factor statistically significantly related to persistence of asthmatic symptoms during follow-up was aggravation of complaints by weather influences (odds ratio: 4; 95% confidence interval: 1-12). The common practice of prescribing antibiotics and oral anti-asthma drugs to young children in general practice is contrary to recent consensus reports on the treatment of asthma. Even in young children referred to specialists with asthmatic symptoms, such symptoms are commonly transient. Aggravation of symptoms by weather influences, which may be an expression of bronchial hyperresponsiveness, is a risk factor for persistence of symptoms