PURPOSE OF THE STUDY.
To compare parent and child subjective assessments of asthma severity and control by using validated measures such as the Childhood Asthma Control Test (C-ACT) and the Scottish Intercollegiate Guidelines Network/British Thoracic Society (BTS) definitions of control.
Families (N = 1284) with a child who had physician-diagnosed asthma who lived in Canada, Greece, Hungary, Netherlands, United Kingdom, or South Africa were included in this cross-sectional survey.
Families were interviewed by using a telephone survey, which included the C-ACT and Global Initiative for Asthma (GINA)/BTS guidelines and subjective questions on asthma symptoms, severity, and control.
Overall, 34.9% of children/adolescents reported a severe asthma attack requiring oral corticosteroids or hospitalization; >50% of the children had awakened at night at least once due to their asthma in the past 4 weeks and two-thirds of the children had used reliever medication in the past 4 weeks. Thirty-three percent of the parents described their child’s asthma as intermittent, 39.9% as mild, 21.1% as moderate, and 6% as severe. Forty percent of subjects had a C-ACT score <19 (indicating poor control); 85% of children/adolescents had incompletely controlled asthma as defined according to GINA guidelines. Thirty-eight of 42 children who described their asthma as “very bad” had poor asthma control according to GINA guidelines; there was poor agreement between parents’ and children’s scores (κ score: 0.119).
Parents often overestimate their child’s asthma control as measured by the comparison between the telephone survey questionnaire and the C-ACT and GINA or BTS/Scottish Intercollegiate Guidelines Network guidelines. The child’s self-reporting of asthma severity showed a stronger correlation with guideline-defined asthma control than the parent’s reporting of the child’s asthma severity.
These results underscore a common clinical observation, that asking parents to assess a child’s asthma status might paint a falsely positive picture. The authors suggest that parents might have difficulty recognizing their child’s asthma symptoms. Thus, these results should encourage clinicians to assess control with pediatric patients by directly asking the child about asthma symptoms, administering validated questionnaires such as the C-ACT or GINA guidelines, and reinforcing asthma symptom identification with the parent.
- Copyright © 2012 by the American Academy of Pediatrics