The influence of variation in type and pattern of symptoms on assessment in pediatric asthma.
OBJECTIVE
We conducted a national, population-based survey to examine the asthma-related health burden of US children.


METHODS
A telephone-based survey was conducted in 2004 of children 4 to 18 years of age with current asthma in the United States. In 41,433 households screened, 1089 children reported current asthma; 801 interviews were completed by parents of children aged 4 to 15 years and by children themselves aged 16 to 18 years. The survey included questions about symptoms, perceived level of control, activity limitations, health care use, medicines, disease management, and knowledge. Global asthma symptom burden, derived from the National Asthma Education and Prevention Program guidelines, was composed of 3 components: short-term symptom burden (4-week recall), long-term symptom burden (past year), and functional impact (activity limitation).


RESULTS
The majority of children were classified with mild intermittent disease on the basis of recent daytime symptoms alone (80%); yet, when report of nighttime symptoms was included, the proportion of children classified as having mild intermittent symptoms decreased (74%). When asthma burden was assessed on the basis of the global symptom burden construct, only a minority (13%) of individuals was classified as having an asthma symptom burden consistent with mild intermittent disease; the majority (62%) was classified as having moderate/severe disease. In addition, the impact of asthma on the daily activities is substantial; avoiding exertion (47%) and staying inside (34%) are common approaches to improve control of asthma symptoms.


CONCLUSIONS
The goals of therapy for asthma, based on the National Asthma Education and Prevention Program guidelines, have not been achieved for the majority of children. In addition, parents and children overestimate the child's asthma control and commonly restrict activities to control asthma symptoms. Deficiencies in the control of asthma may be related to the underestimation of the burden of disease.
Fuhlbrigge
Anne L
AL
Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, Massachusetts 02115, USA. anne.fuhlbrigge@channing.harvard.edu
Guilbert
Theresa
T
Spahn
Joseph
J
Peden
David
D
Davis
Kourtney
K
D000293:Adolescent; D000818:Animals; D000829:Animals, Domestic; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D005260:Female; D005541:Forced Expiratory Volume; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D010290:Parents / Q000523:psychology; D010361:Patients / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data
D018927:Anti-Asthmatic Agents; D014028:Tobacco Smoke Pollution