SAN FRANCISCO – Parents of urban children with asthma tend to overestimate their child’s asthma control, but the factors predicting this association remain unclear, a study has shown.
"There’s a disconnect," lead investigator Joy N. Saams, R.N., said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "We tried to look for what made overestimating parents different from other parents. We had a hard time setting them apart."
Ms. Joy N. Saams, R.N.
In an effort to determine if parents’ perception of their child’s asthma was consistent with their child’s asthma control, Ms. Saams and her associates evaluated data from a 1-year observational study of 150 children aged 5-17 years with persistent asthma who lived in Baltimore. All children underwent spirometry. Days of symptoms and rescue medication use as well as parent/guardian perception of the child’s asthma were determined by questionnaire, said Ms. Saams of the division of pediatric allergy and immunology at Johns Hopkins University, Baltimore.
She and her associates defined misperception of asthma control as parent report of well-controlled asthma when the child’s asthma met National Asthma Education and Prevention Program criteria for disease that is not well controlled or is poorly controlled. They administered a questionnaire to determine family income, education level of the parents, and risk of depression, which was defined as scoring higher than 8 on the 10-item Center for Epidemiologic Studies Depression Scale.
The mean age of the children was 12 years, 57% were male, 91% were African American, and 53% were from households with an income of less than $25,000 per year. Nearly half of the children (43%) had asthma that was not well controlled, 32% had asthma that was poorly controlled, and 25% had asthma that was well controlled. Boys were significantly more likely than girls to have uncontrolled asthma (81% vs. 67%), Ms. Saams reported.
Parents of children with well-controlled asthma were significantly more likely to believe that their child’s asthma was well controlled, compared with parents of children with uncontrolled asthma (90% vs. 67%). "The good news may be that 90% of parents correctly identified well-controlled asthma, but 67% did not recognize uncontrolled asthma," Ms. Saams commented. "The story isn’t about who got it right, but who got it wrong."
When only reported symptoms and use of short-acting beta-agonists determined control, 62% of parents still believed that their child’s asthma was well controlled when it was not.
Although there were no statistically significant predictors of parent overestimation of asthma control, parents with less education and those with older children were more likely to overestimate their child’s asthma control, compared with parents who had higher levels of education and younger children.
There was no significant association between overestimating asthma control and increasing use of health services, but a larger percentage of children whose parents overestimated disease control had acute health care visits (56% vs. 45% among parents who did not overestimate asthma control).
The researchers concluded that parents of urban children with persistent asthma may benefit from explicit education regarding assessment of asthma control. "When you’re working with a parent and imparting education regarding asthma, pay attention to their background," Ms. Saams advised. "Are you reaching them at their level of understanding? Help them realize not only when their child’s having symptoms, but [also] that when they do have symptoms, that indicates a problem."
The study was funded by grants from the National Institute of Environmental Health Sciences and the National Institute of Allergy and Infectious Diseases.
Ms. Saams said that she had no relevant financial disclosures.