Providers underestimate symptom severity among urban children with asthma.
BACKGROUND
Guidelines recommend that children with mild persistent to severe persistent asthma receive maintenance anti-inflammatory medications. However, providers may not be aware of the severity of their patients' symptoms. The underestimation of severity may contribute to poor adherence to asthma care guidelines.


OBJECTIVE
To describe the use of preventive medications among a group of urban children with mild persistent to severe persistent asthma and to evaluate the degree to which their health care providers are aware of their asthma severity.


METHODS
Children (ages 4-6 years) from urban schools in Rochester, NY, were eligible if their parents reported mild persistent to severe persistent asthma symptoms. Each child's health care provider was asked to assess the child's asthma severity and use of medications based both on their knowledge of the child and review of the medical record. Parent and provider assessments were compared. Bivariate and regression analyses were used to identify factors associated with concordant classifications of asthma severity.


RESULTS
Ninety children with parent-defined mild persistent to severe persistent asthma participated (64% boys, 67% black, 73% receiving Medicaid). Only 40% of the children were described accurately by their providers as having mild persistent to severe persistent asthma, and only 50% of the total had been prescribed maintenance medications. Thirty-six percent of families reported that their child used maintenance medications daily. In contrast, most of the children who were classified by their provider as having mild persistent to severe persistent asthma were prescribed a maintenance medication (83%), and 58% used them daily. Sociodemographic characteristics and asthma severity were not associated with provider accuracy.


CONCLUSIONS
Most children in this study were not accurately classified by their providers as having mild persistent to severe persistent asthma and had not been prescribed maintenance medications. When providers were aware of their patient's asthma symptoms, most of the children were prescribed maintenance medications. Attempts to improve adherence to asthma guidelines should take into consideration provider underestimations of asthma severity.
Halterman
Jill S
JS
Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Yoos
H Lorrie
HL
Kaczorowski
Jeffrey M
JM
McConnochie
Kenneth
K
Holzhauer
Robert J
RJ
Conn
Kelly M
KM
Lauver
Sherri
S
Szilagyi
Peter G
PG
D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000145:classification* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006282:Health Personnel; D006801:Humans; D016015:Logistic Models; D008297:Male; D009518:New York; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014505:Urban Population
D018927:Anti-Asthmatic Agents