Lung function and symptom perception in children with asthma and their parents

Abstract

A large proportion of children with asthma are managed without recourse to specialized care, and treatment decisions are based solely on symptoms as reported by the children and their parents. We investigated 90 school-age children with the diagnosis of asthma and their accompanying parent to evaluate whether we can obtain better information by using three different means of asking for asthma symptoms: a questionnaire for children (QSR(children)), "smilies," and a visual analogue scale for children (VAS(children)). Furthermore, we analyzed the relationship between these symptom reports and lung function results. Finally, we attempted to determine whether performing a lung function test contributes relevant information toward improving asthma management. Multiple linear regression adjusted for age and gender showed a significant relationship between VAS for children and forced expiratory volume in 1 sec (FEV(1)) (P = 0.047) and maximal expiratory flow at 50% of forced vital capacity (MEF(50)) (P = 0.037). Neither age, gender, QSR for children, "smilies for children" nor all the parents' scores showed a significant association with lung function measurement in the regression model. Subgroup analysis with Spearman's rank correlation coefficients by age group revealed significant correlation in children <10 years between VAS for children, QSR for parents, smilies for parents, and the lung function parameters FEV(1), and MEF(50). Above age 10 years there was no correlation at all, with the accuracy correlation ranging from -0.04 to +0.21. Our data demonstrate that reported symptoms do not reliably correlate with lung function results in asthmatic children and the childrens' parents, and correlation is dependent on the instrument used for symptom evaluation. In children, the VAS, and in parents, the QSR were the most valuable means of obtaining best information on asthma symptoms. This underlines the importance of supplementing information on asthma symptoms with lung function measurements to more reliably assess the severity of asthma.

Parent-Child Agreement in Report of Nighttime Respiratory Symptoms and Sleep Disruptions and Quality

“…This finding is similar to what others have suggested for report of daytime symptoms (Braun-Fahrlander et al, 1998;Fritz, McQuaid, Spirito, & Klein, 1996;Horak, Grassl, Skladal, & Ulmer, 2003;Lara et al, 1998);Mittal, Khanna, Panjabi, & Shah, 2006;Renzoni et al, 1999). Parents and children can be taught symptom specific identification skills, such as wheezing (Lee, Arroyo, & Rosenfeld, 1996), and this can be a focus of educational efforts, especially if the child has moderate-severe symptoms where inaccurate appraisal has had the greatest negative impact on control assessments (Halterman, 2006).…”

Home spirometry and asthma severity in children

“…These findings concur with earlier studies using mechanical PEF meters [27]. Some of these patients may be regarded as ''poor perceivers'', with few symptoms despite considerable variation in PEF and FEV1 and others as patients with excessive symptoms without any variation in PEF and FEV1 [28]. It would be interesting to see whether poor perceivers, identified by home recordings, could benefit from stepping up therapy, but this study was not designed to answer that question.…”

Wheezing in Chinese schoolchildren: disease severity distribution and management practices, a community‐based study in Hong Kong and Guangzhou

“…In most published guidelines, asthma severity classification involved the use of lung function parameter [7,20]. A previous study suggested in school-age children, reported symptoms by both the children and parent did not reliably correlate with lung function [21]. In another study, concordance between functional evaluation and clinical status was only found for moderate persistent asthma but not for intermittent and mild persistent asthma [22].…”