title: Subjective symptom perceptual accuracy in asthmatic children and their parents in India.
abstract: BACKGROUND
  Inaccurate symptom perception is a key factor in increased morbidity and mortality in asthmatic patients. Information is sparse on whether children and their parents can accurately perceive severity of symptoms.
  
  
  OBJECTIVE
  To determine symptom perceptual accuracy in children with asthma and either of their parents.
  
  
  METHODS
  Fifty-two asthmatic children and either of their parents recorded independently, for 2 weeks, subjective evaluation of the child's symptoms on a 100-mm visual analog scale (VAS). Peak expiratory flow (PEF) was used as an objective measurement. Both VAS and PEF data were graded into green, yellow, and red zones. The 2 sets of VAS zones (children and parents) were separately matched with PEF zones to determine perceptual accuracy.
  
  
  RESULTS
  Children and parents were accurate more than half of the time (60% and 62%, respectively), but accuracy decreased when the "child was unstable" (PEF <80% of personal best), with underestimation being significant (P < .001). Among the readings obtained, underestimation of severity of symptoms was significant in children with severe asthma (125 [45%] of 278 readings), those affected by environmental tobacco smoke (130 [24%] of 532), and those in the younger age group (127 [45%] of 280). Underestimation was significantly greater when PEF readings were in the yellow zone (P < .001).
  
  
  CONCLUSIONS
  Symptom perception by children was as reliable as that by their parents. However, parents and children tended to underestimate severity when the child was unstable. An early decline in PEF readings was missed by children and their parents, which could contribute to increased morbidity and mortality in this vulnerable age group.
authors.affiliation: Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mittal
authors.forename: Puneet
authors.initials: P
authors.lastname: Khanna
authors.forename: Chandramani
authors.initials: C
authors.lastname: Panjabi
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
mesh_terms: D001249:Asthma / Q000503:physiopathology / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007194:India; D010290:Parents / Q000523:psychology*; D010465:Perception; D015203:Reproducibility of Results; D012720:Severity of Illness Index