Table 3 gives the mean European order of chronic treatment in adults and in children. It is based on a ranking of the mean scores of the different modalities of treatment. For the answers in children, responses of the pediatricians were added to those of the ± 63 percent of the adult specialists also responding for children. The order of treatment is quite different for the two age groups. Inhaled beta-agonists are the first choice in adults while inhaled cromoglycate is first in children. Four drugs in adults and three in children are on average used “often or always” as first line for maintenance by more than 45 percent of the responding specialists.
However, this mean European order represents an average of considerable differences in opinion between specialists of individual countries. As an example, there is a clear preference for oral theophylline above inhaled beta-agonists in adults in France and Portugal, and specialists of Great Britain and Scandinavia prefer inhaled beta-agonists above inhaled cromoglycate in children. Table 4, based on the answers of adult specialists only, attempts to illustrate some differences between countries for four drugs and also for desensitization in allergic asthma. In each column the four countries with the highest percentages and the four with the lowest percentages for using the treatment “often or always” are listed above and below the MEA.
From this wide spectrum of percentages some clear regional trends can be identified. In Great Britain, inhaled beta-agonists and steroids are highly rated, whereas oral theophylline and desensitization have a particularly low use. In Scandinavia there is also frequent use of inhaled beta-agonists and steroids, but inhaled cromoglycate is rather poorly rated. In France, Belgium, and the Netherlands, the only clear pattern is the lower use of inhaled beta-agonists. Germany, Austria and Switzerland have in common a rather high use of theophylline and desensitization, whereas in southern Europe, there is a trend for frequent use of desensitization (Greece excepted) and a low use of inhaled beta-agonists and steroids. To start asthma treatment you may with the help of asthma ventolin inhaler which may be bought via the Internet as well as in the ordinary drug stores.
Recommended Metered Dose and Alternatives
Specialists of countries with a less frequent use of inhaled beta-agonists or steroids are generally also more reluctant to recommend adequate usual and maximal metered-doses of these aerosols. This is brought out in Table 5, showing that in several countries half of the physicians do not exceed 5 puffs as a usual dose and 10 puffs as a maximal tolerated dose of beta-agonists; the scatter of percentages is smaller for inhaled steroids and ventolin inhalers.
If a metered-dose aerosol of beta-agonists cannot be used satisfactorily, the oral formulation is on average the first choice for an alternative, followed by, respectively, the use of powdered inhaler, the addition of a spacer to the metered-dose, and the nebulization of the drug in soluble form. There was again a wide scatter of opinions, however, without clear regional patterns; this probably results from differences in availability of the alternatives in different countries.
Table 3—Chronic Treatment of Stable Asthma
|Mean European Order of Treatment|
|Adults (n = 735)||Children in = 674)|
|inhaled beta-agonist||inhaled cromoglycate|
|oral theophylline||inhaled beta-agonist|
|inhaled steroids||oral theophylline|
|inhaled cromoglycate||oral beta-agonsst|
|inhaled anticholinergic||oral ketotifen|
|oral beta-agonists||inhaled steroids|
|oral steroids||inhaled anticholinergic|
|oral ketotifen||oral steroids|
Table 4—Chronic Treatment of Stable Asthma by Adult Specialists
|Rank||(% using OFTEN and ALWAYS) Use as First Line for Maintenance||Desensitization for Allergic Asthma|
Table 5—Recommended Metered-Dose in Adults (% Recommending)
|rank||Inhaled usual >5 P*||3-Agonists maximal >10 P*||Inhaled usual >5 P*||Steroids maximal >10 P*|