Congruence of Perception of Asthma Control Between Parents, Children & Clinicians

Childhood asthma is a serious public health issue due to high prevalence and costs. It affects approximately 7 million children ages 0-17 years. Under perception of asthma symptoms is a risk factor for ED visits and hospitalizations in children. Perception of pulmonary function and adherence to controller medications is worse in Puerto Rican and African-American children versus Caucasian children. Accurate perception of asthma symptoms and control and medication adherence is key to improving outcomes. Purpose: This secondary analysis examined differences in parent and child perceptions of asthma control and compared these subjective perceptions with clinician ratings. Subjects: Data were collected from 514 Mexican and Puerto Rican caregivers and children ages 5-12 with persistent asthma. Families were recruited from clinics in Phoenix, AZ and Bronx, NY. Method: Structured interviews with parents and children, spirometry, and children’s medical records reviews were conducted at enrollment, and 3, 6, 9, and 12 months post-enrollment. Results: 79% (N=195) of parents rated their children as well-controlled yet 41% (N=80) were rated as poorly controlled by the clinician. The child may be at risk because medications may not be initiated or increased as required. 89% (N=221) of children viewed their asthma as poorly controlled while 51% of these children were rated as well-controlled by the clinician. Over-perception of symptoms may lead to excess medication use. Conclusions: Significant discrepancies exist between parent’s and children’s subjective perceptions of control and clinician-rated control. Interventions targeting symptom perception and medication adherence may result in decreased healthcare utilization and costs.