Seasonality of medical contacts in school-aged children with asthma: Association with school holidays

• Published in: Public health (London) Vol. 125; no. 11; pp. 769 - 776
• Main Authors: Julious, S.A, Campbell, M.J, Bianchi, S.M, Murray-Thomas, T
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-11-2011
• Subjects: Adolescent; Adrenal Cortex Hormones - administration & dosage; Anniversaries and Special Events; Asthma; Asthma - therapy; Child; Children; Corticosteroids; England; Female; Health Services - utilization; Humans; Infectious Disease; Inhaled corticosteroid; Internal Medicine; Male; Medication Adherence; Practice Patterns, Physicians' - statistics & numerical data; Prescriptions; Retrospective Studies; Schools; Scotland; Seasonality; Seasons; Students - statistics & numerical data; England; Scotland; Seasonality; Inhaled corticosteroid; Asthma
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2011.08.005

Summary Objectives To assess the seasonality of medical contacts in children with asthma, to compare England with Scotland, and to assess the impact of medication compliance on the frequency of medical contacts. Study design A retrospective study taken from the General Practice Research Database of daily medical contacts from 1999 to 2005 in a population of school-aged (5–16 years) children with a diagnosis of asthma, and age- and gender-matched controls. Primary outcome measure All unscheduled medical contacts. Prescription frequency for inhaled corticosteroids over the same period was also assessed. Results Data from 76,924 children were analyzed. There was an increase in unscheduled medical contacts for all children on return to school in September. Unscheduled medical contacts occurred almost twice as frequently in children with asthma compared with non-asthmatic children. The frequency of medical contacts in children with asthma could be predicted from the frequency of medical contacts in non-asthmatic children. In the 3 months from September to December, unscheduled medical contacts were disproportionately greater than would be predicted for children with asthma relative to non-asthmatic children in both England and Scotland. The rise in medical contacts in Scotland preceded that in England by approximately 14 days, reflecting the earlier date for returning to school. The number of prescriptions for inhaled corticosteroids decreased in August. A higher incidence of unscheduled medical contacts was noted during September in those not receiving a prescription in August. Conclusions Returning to school after the summer break is associated with a sharp increase in unscheduled medical contacts in school-aged children, particularly in those with asthma. This follows a decrease in the number of prescriptions for inhaled corticosteroids. It is suggested that at least part of the excess numbers of unscheduled contacts in children with asthma is because they do not maintain their inhaled corticosteroids over the summer holidays.