Pediatric Medicine

Wheeze aren't the champions

Canada's facing higher asthma prevalence in kids
� but strangely it's costing us less than ever. What gives?

By Robb Beattie

Any doctor who's treated a wheezing, coughing child will have an intimate understanding of the burden of pediatric asthma. Most of you won't be surprised to hear that this common disorder is on the rise in Canada, not to mention in the rest of the rapidly urbanizing world. Two recent reports offer some good news, and some bad, for childhood asthma in Canada.

THE GOOD NEWS
"The Burden of Childhood Asthma," a report published in May by the Institute for Clinical Evaluative Sciences (ICES) in Toronto, gives Canadian physicians a reason to breathe easier. While the overall prevalence of asthma in Ontario kids up to nine years old has been steadily increasing year by year, the Ontario Health Insurance Plan (OHIP) claim rate per individual with asthma dropped by 40% between 1994 and 1999. Total expenditures for asthmatic kids aged nine years old and younger fell by about 15% between 1994 and 1999 � around 81% of the claims were for physician consults and emergency room visits. Hospitalization rates for pediatric asthma fell by 42% over the study period.

"We're not too sure why there's an overall decrease in expenditure per child and overall between 1994 and 1999," says study author Dr Teresa To, Senior Scientist in Population Health Sciences at the Hospital for Sick Children. "We could hypothesize that we're achieving much better control through medication. The aggressive use of inhaled corticosteroids by many patients certainly means fewer trips to physicians."

Dr To is working on smaller studies for Sick Kids and ICES to look at medication use and compliance with Canadian consensus guidelines for asthma management. She admits that tracking medication use in children is difficult. "There are good indications that physicians in Ontario are following the guidelines," she says. "Medications are being prescribed appropriately, Hospitalizations due to asthma came down dramatically between 1994 and 1999, and a lot of kids are really quite well managed now in an outpatient setting."

THE BAD NEWS
According to a new report released by the World Health Organization (WHO) and the Global Initiative for Asthma (GINA), there are 300 million asthma sufferers in the world today, and that number is expected to jump to 400 million over the next 20 years. Canada has the dubious honour of placing seventh on the worldwide leader board for asthma prevalence in 13- and 14-year-old children. A record 14.1% of the overall Canadian population now suffers from asthma; that rate's been steadily increasing since the 1960s.

The report, "The Global Burden of Asthma," finds regions like North America and the British Isles, have some of the world's highest prevalence. But the reasons are still foggy. The report warns that child asthma rates are increasing internationally because countries are adopting Western lifestyles and becoming more urbanized. But a concrete connection between economic development and child asthma increases still eludes the experts. "We wish it was easy to plot what it is about urbanization and affluence that affects asthma," says report lead author Dr Richard Beasley, of the Medical Research Institute of New Zealand. "The fact is we simply don't know."

For more from this report, please visit www.ginasthma.com