Children Often Rate Their Asthma Worse Than Parents Report

Kate Johnson

November 12, 2014

ATLANTA — Parental assessment of a child's asthma severity can sometimes underestimate the child's level of discomfort and control, according to the results of a study presented here at the American College of Allergy, Asthma & Immunology 2014.

"This gap in perceptions of asthma control among children and caregivers can be improved with patient education of asthma symptoms and management by healthcare providers," said Priya Patel, MD, from Rutgers New Jersey Medical School in Newark.

"This is an important finding since clinical providers often rely on the parental assessment of asthma control to make therapeutic decisions," said Chitra Dinakar, MD, from the University of Missouri–Kansas City, who was not involved in the study.

"It highlights the importance of taking the child's opinion into consideration when estimating the degree of asthma control and making management decisions," Dr Dinakar told Medscape Medical News.

The researchers retrospectively reviewed the charts of 114 children with asthma who were 4 to 11 years of age and 57 young people with asthma who were 12 to 20 years of age.

In the children, asthma symptoms were measured with the Childhood Asthma Control Test, which includes questions for both the patient and the parent or caregiver.

In the youth, symptoms were measured with the Asthma Control Test, which is completed by patients only.

On the Childhood Asthma Control Test, caregiver scores were an average of 7% higher than patient scores, meaning that the caregivers were more likely than the children to believe the asthma was well controlled.

Medication Changes

The researchers also looked at medication changes related to test responses.

When scores indicated poor control, 39% of children and 36% of youth received a step-up in medication. When scores indicated good control, 76% of children and 81% of youth received a decrease or maintenance dose.

"While these findings need to be validated in a larger study, these results are very interesting. They affirm our clinical suspicion that caregivers and children differ in their perceptions of asthma control," said Dr Dinakar.

"In our clinical practice, we have observed that younger children tend to be more discomfited by asthma symptoms and often rate them as 'it's a problem and I do not like it,' or 'it's a problem and I can't do what I want to do,' on the Childhood Asthma Control Test," Dr Dinakar reported. However, "teenagers often tend to underestimate their lack of asthma control and report optimistically that 'their asthma is well controlled' when they fill out the Asthma Control Test."

Dr Patel has disclosed no relevant financial relationships. Dr Dinakar reports that she has received speaker fees from Aerocrine, GlaxoSmithKline, and Teva.

American College of Allergy, Asthma & Immunology (ACAAI) 2014: Abstract 21. Presented November 9, 2014.

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