Drs. Lipstein, Perrin and Kuhlthau,
Thank you for this interesting analysis of a 561 parent-child dyads from
the 2003 NHIS. It is a significant contribution to our understanding of
school absenteeism among students with asthma.
As you noted, it is difficult to select an unbiased severity proxy
from the NHIS questions. Your choice of whether the child had used an
"inhaler that you breathe in through your mouth, that gives quick relief
from asthma symptom" in the previous 3 months is less confounded by
compliance or health care access than other measures. It, however, seems
more of a measure of current asthma than severe asthma. It would unusual
for someone with persistent asthma to be under such extremely good control
that they would never use a SABA inhaler in the previous 3 months. (It
would be more likely for off-season seasonal asthma.)
Did you consider using this proxy as another measure of current
asthma? What proportion of dyads were reported to “still have asthma” and
not use a SABA within 3 months? What proportion of these reported having
an asthma attack? One might infer that this subset did not have access
to SABA.
Did you consider using this proxy as a measure of asthma control? It
would be an extremely tight measure but a better approximation of control
than severity. I suspect that you’ve had some of these discussions and
I’m interested in your thoughts.
Again, thank you for this excellent paper. Lani
Conflict of Interest:
None declared
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