Airway symptoms and atopy in young children prescribed asthma medications: A large-scale cohort study

Ingvild Bruun Mikalsen, Ingvild Dalen, Øystein Karlstad, Geir Egil Eide, Maria Magnus, Wenche Nystad, Knut Øymar

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Diagnosing asthma and deciding treatment is difficult in young children. An inappropriate and too high prescription rate of inhaled corticosteroids (ICS) is suggested, but how airway symptoms are associated with prescriptions of asthma medication is less known. We studied how strongly wheeze, lower respiratory tract infections (LRTI) and atopic diseases are associated with dispensing of asthma medications during early childhood.
We used data from the Norwegian Mother and Child Cohort Study and the Norwegian Prescription Database at four age-intervals (0-6, 6-18, 18-36 months and 3-7 years). Primary outcomes were dispensed asthma medications (no medication, short-acting β-2 agonist or ICS). Relative risks (RRs) and average attributable fractions (AAFs) were estimated. Both wheeze and LRTI were positively associated with both medication groups (0-6 months: no data on wheeze). The RRs and AAFs were higher for wheeze than LRTI. For ICS,
the AAFs (95%CI) for wheeze vs LRTI were: 6-18 months: 69.2 (67. 2, 71.2)% vs 10.4 (9.0, 11.8)%, 18-36 months: 33.0 (30.5, 35.5)% vs 10.0 (8.0, 12.0)%, 3-7 years: 33.7 (31.0, 36.5)% vs 1.2 (0.5, 1.9)%. Except at 3-7 years of age, the AAFs were lower for atopic diseases than for LRTI and wheeze. Atopic diseases modified the associations between wheeze and ICS at 18-36 months and between LRTI or wheeze and ICS at 3-7 years.
In conclusion, both wheeze and LRTI were associated with prescriptions of asthma medications in young children, with the strongest associations seen for wheeze. Atopic diseases contributed to these associations only in the oldest age groups.
Original languageEnglish
Pages (from-to)1557-1566
Number of pages10
JournalPediatric Pulmonology
Issue number10
Early online date4 Jul 2019
Publication statusPublished - 1 Oct 2019


  • airway symptoms
  • allergy
  • asthma and early wheeze
  • asthma medication
  • atopy
  • children
  • pharmacology
  • prescription
  • the Norwegian Mother and Child Cohort Study (MoBa)


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