83.1% of children prescribed respiratory medication in first 10 years
Key takeaways:
- Frequently prescribed respiratory medications included inhaled corticosteroids and short-acting beta 2-agonists.
- General practitioners gave out the most prescriptions, followed by pediatricians.
Among children born in France, 83.1% had been prescribed a respiratory medication during the ages of 0 through 10 years, according to results published in Respiratory Medicine.
“Our results align with international and French recommendations for the management of asthma in children, which favor [inhaled corticosteroids] as the first-line treatment and suggest combinations with [leukotriene receptor antagonists] for children under 5 or LABAs for children over 5 as a second-line treatment,” Justine Benevent, PharmD, PhD, of the Center for Epidemiology and Research in Population Health at INSERM, and colleagues wrote.
In a longitudinal, population-based study, Benevent and colleagues evaluated 5,956 children in France from the POMME birth cohort to determine the prevalence of respiratory medication prescriptions during the ages of 0 through 10 years.
Over 80% of the total cohort (n = 4,951; 83.1%) had been prescribed at least one respiratory medication, according to researchers.
Frequently prescribed medications included inhaled corticosteroids (95.3%; n = 4,718) and short-acting beta 2-agonists (SABA; 68.8%; n = 3,407). Smaller proportions of children received leukotriene receptor antagonists (LTRA; 14.2%; n = 704), long-acting beta 2-agonists (LABA; 13.6%; n = 675) and long-acting muscarinic antagonists (LAMA; 0.3%; n = 17).
Ninety-four percent of the prescriptions for inhaled corticosteroids were for this medication alone. Of the combinations including inhaled corticosteroids, researchers found that inhaled corticosteroids plus LABA were prescribed the most (12.8%; n = 634).
Each child had 8.1 prescriptions on average, which researchers deemed “relatively low.” Similar to the above finding, the medications with the highest average number of prescriptions included inhaled corticosteroids (6.7 per child) and SABA (five per child).
Children prescribed inhaled corticosteroids had the youngest average age of first prescription among the five assessed medications at 1.7 years. SABA came next (average age, 2.3 years), followed by LAMA (2.7 years), LTRA (3.6 years) and LABA (5.3 years).
“Notably, LABAs had a mean age at first prescription exceeding 5 years, as these medications lack marketing authorization before the age of 4, making the prescriptions in younger children off-label,” Benevent and colleagues wrote.
Compared with the number of prescriptions for inhaled corticosteroids alone at younger than age 6 months (n = 967), researchers observed a rise in this prescription between the ages of 6 months and 2 years (n = 3,108), 2 years and 4 years (n = 2,891) and 4 years and older (n = 2,886).
The number of SABA prescriptions followed a similar pattern, with a higher number of prescriptions found between ages 6 months and 2 years, 2 years and 4 years, and 4 years and older vs. younger than 6 months (1,660 vs. 731 vs. 637 vs. 379).
The highest number of prescriptions for inhaled corticosteroids plus LTRAs was found between the ages of 2 years and 4 years (n = 139), followed by between the ages of 6 months and 2 years (n = 124), 4 years and older (n = 104) and younger than 6 months (n = 4).
Additionally, as children grew older, the number of prescriptions for inhaled corticosteroids plus LABA gradually rose (< 6 months, n = 5; 6 months to 2 years, n = 46; 2 years to 4 years, n = 149; 4 years and older, n = 434).
The same was true for LTRA prescriptions alone (< 6 months, n = 2; 6 months to 2 years, n = 111; 2 years to 4 years, n = 162; 4 years and older, n = 205) and inhaled corticosteroids plus LABA plus LTRA prescriptions (< 6 months, n = 1; 6 months to 2 years, n = 4; 2 years to 4 years, n = 38; 4 years and older, n = 82).
“It is noteworthy that the number of children exposed to LTRA alone increased with age, with a significant number of children exposed after 5 years,” Benevent and colleagues wrote. “This use of LTRA alone is not in line with recommendations.”
Researchers found that general practitioners gave out the most prescriptions (63%), followed by pediatricians (32%), pulmonologists (2%), ENT specialists (2%) and other specialists (1%).
“While these medications are primarily indicated for asthma management, our findings suggested a significant proportion of prescriptions may be related to occasional respiratory infections, particularly in children under 4 years, where asthma diagnosis is more challenging,” Benevent and colleagues wrote. “Many of these prescriptions appear to be off-label, underscoring the need for further research and clinical guidance to ensure appropriate medication use in pediatric populations.”
Perspective
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This French study on medications prescribed for respiratory illness in children aged 0 to 10 years reveals concerning trends needing intervention. Despite asthma prevalence being less than 10%, 83.1% of children received respiratory medications which shows that widespread off-label medications are used for other conditions such as viral illnesses and bronchiolitis.
This goes against the guidelines from the French Health Authority and Global Initiative for Asthma (GINA), which discourages such practices. Even in the U.S., similar patterns exist with inhaled corticosteroids and SABA often prescribed for recurring wheezing or viral symptoms without a confirmed asthma diagnosis.
This is driven by diagnostic uncertainty, parental pressure and habitual prescribing, which highlights the gap between guidelines and real-world practice. The use of inhaled corticosteroids for short term relief rather than chronic asthma control raises concern for unnecessary exposure to side effects such as growth suppression or neuropsychiatric risks.
Strategies are needed to work on the challenges. Physicians must adhere to evidence-based guidelines from both GINA and the American Academy of Pediatrics that emphasize supportive care over bronchodilators for bronchiolitis in children aged younger than 12 months. Provider education with recent advances is essential to stay up-to-date along with decision support tools in electronic health records to reduce off-label prescriptions. Counseling parents, educating families and shared decision-making about the self-limiting nature of viral illnesses and the limited role of medications can also alleviate pressure on clinicians to prescribe.
The study has limitations, which includes exclusion of children with interrupted follow-up and the lack of diagnostic data, which raises the question whether prescriptions are aligned with clinical indications. Moreover, the regional French data may not reflect prescribing patterns in the U.S., where health care access is different.
In order to bridge these gaps, further research should correlate prescriptions with diagnosis to clarify appropriateness, investigate long-term outcomes regarding off-label medication use and evaluate interventions such as educational programs for providers.
Practitioners are advised to reduce unnecessary prescriptions for pediatric respiratory infections, which, in turn, reduce medication risks, lower health care costs and improve compliance with evidence-based medicine. Patient safety can be enhanced by following these guidelines, prioritizing education and addressing parental expectations. Insights from one health care system can drive progress in another, ultimately fostering better outcomes for children worldwide.
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