In a leading article published in the Archives of Disease in Childhood, Andrew Bush and Louise Fleming of Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College London assert that “the diagnosis of asthma has been trivialized and inhalers dispensed for no good reason, and have become almost a fashion accessory,” which has contributed to continuing deaths among children due to “failures in basic management.”
While asthma was often underdiagnosed in the past, the authors say, it is now often overdiagnosed, leading to unnecessary treatment of children with inhaled corticosteroids.
Unnecessary use of ICS not only represents a significant financial burden, the authors say, it also puts children at risk of growth suppression and possibly respiratory infections. “Is there any other chronic disease in the world in which children are committed to potentially hazardous, longterm therapy without every effort being made objectively to document the diagnosis?” they ask.
The authors implore doctors to avoid thoughtlessly escalating the dose when children do not respond to ICS and ask them to instead consider whether the diagnosis of asthma was correct in the first place.
It would be helpful, they say, if doctors could obtain placebo inhalers in order to conduct trials for individual children and if electronic monitoring could determine whether a child has actually inhaled their medication or simply activated the device without inhaling. Phenotyping of pediatric respiratory diseases would also help to ensure correct treatment, Bush and Fleming conclude.
Read the Archives of Disease in Childhood article.
