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Background: Data on the efficacy and safety of long-acting β2-agonists (LABA) in children are limited, and current guidelines recommend that LABA always be used with inhaled corticosteroids (ICS).Objective: To compare asthma control, assessed by rescue medications use, in children prescribed LABA and ICS as a fixed-dose combination (LABA/ICS) or concurrently via separate inhalers (LABA+ICS).Methods: Retrospective observational study of asthma medication prescribed to children aged 0-18 years registered with 40 primary care practices for the years 2002-6. Asthma control, reflected by requirement for oral corticosteroids (OCS) and/or six or more short-acting β2-agonist (SABA) canisters per year, was assessed for children prescribed LABA/ICS or LABA+ICS.Results: 10,454 (8%) of all registered children received at least one prescription for asthma medication over the study period. Prescribing of LABA/ICS increased significantly, with a concomitant decrease in prescribing of LABA+ICS. Use of OCS increased by 60%, with the lowest use in children prescribed only SABA and highest use in those prescribed LABA. Children prescribed LABA/ICS were significantly less likely than those prescribed LABA+ICS to require OCS rescue therapy and or >6 SABA inhalers a year (OR 1.6; 95% CI 1.1 to 2.2; p=0.04 and OR 1.7; 95% CI 1.1 to 2.5; p=0.005, respectively, for the years 2005-6).Conclusions: The results of this retrospective observational study suggest that children prescribed fixed-dose LABA-and-ICS combination devices achieve better asthma control, as reflected in reduced requirements for SABA and reduced courses of OCS than equivalent doses in separate devices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess current attitudes of hospital based paediatricians to off label prescribing, and the performance of clinical trials in children. DESIGN: A prospective, questionnaire based study. SETTING: 257 hospital based consultants and specialist registrars in paediatric practice in Scotland during 2003-2004. RESULTS: A 25 item questionnaire was sent to 257 hospital based paediatricians and 151 (59%) were returned completed. Over 90% of responders were familiar with the concept of, and knowingly prescribed, off label drugs; 55% of responders stated that such prescribing disadvantaged children, and 47% expressed concerns about the efficacy of off label medicines. Although 70% of responders expressed concerns about safety, only 17% had observed an adverse event, and 47% a treatment failure, while 69% did not obtain informed consent or tell parents they were prescribing off label, and 67% did not inform the family's general practitioner. Many respondents did not believe it was necessary to carry out clinical trials in children for new (46%) or generic (64%) medicines. However, 52% of respondents stated that they would be willing to undertake clinical studies and recruit their own patients (61%) or children (73%) to take part in such studies. CONCLUSIONS: Among Scottish paediatricians there is concern about off label prescribing, although the majority do not consider it necessary to inform parents or GP colleagues. The need for clinical trials in children was recognised but there was a less than wholehearted acceptance of the need for such studies, at variance with the current drive to promote clinical trials in this age group. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of British asthma management guideline revisions. Concerns about the use of high dose inhaled corticosteroids (ICS) in children have resulted in the promotion of add-on therapy., Aims: To assess prescribing patterns of asthma medication in children in the primary care setting., Methods: Retrospective observational study of asthma prescribing in children aged 0-18 years using primary care database from 2001 to 2006., Results: The proportion of children prescribed oral corticosteroids increased significantly (from 6% in 2001-2002 to 16% in 2005-2006, p<0.001), while the proportion of children prescribed an ICS dose of >400 mcg decreased from 16.2% to 11.7% (P<0.001). The proportion of children prescribed an add-on therapy and an ICS dose >400 µg, increased from 38.8 % in 2001-2002 to 61.2% in 2005-2006 (p<0.001)., Conclusions: Although adherence with asthma management guidelines is not optimal, this study has identified improved adherence in primary care.

Aims: To determine the extent of combined oral contraceptive use by girls aged 10-16 years in Scotland., Methods: Assessment of combined oral contraceptive prescribing in 35 414 girls for the year 1 November 1999-31 October 2000 from data retrieved from 161 primary care practices taking part in the Scottish Programme for Improving Clinical Effectiveness in Primary Care, and from national aggregated data from family planning clinics., Results: During the study period the oral contraceptive pill (OCP) was prescribed by a primary care physician to 1531 girls (4.3%) aged 10-16 years. The age specific prevalence rates per 1000 girls registered with their family doctor rose from 0.9/1000 girls aged 12 years or younger, to 6.9, 30, 86.3, and 174.8/1000 for girls aged 13, 14, 15, and 16 years respectively. The overall prevalence of combined oral contraceptive prescribing by primary care physicians was 43.2/1000 girls aged 10-16 years. A further 1765 girls aged 13-16 years obtained a prescription for the OCP from a Scottish family planning clinic, giving an overall prevalence rate for family planning clinic prescribing of 8.0/1000 girls aged 10-16 years. Despite reportedly high levels of sexual activity and teenage pregnancy in this age group, these results confirm that OCP use is relatively low., Conclusions: The UK has the highest rate of teenage pregnancy in Western Europe, but despite the medical and social concerns about the sexual health of teenagers, the level of oral contraceptive use in this young age group remains low.