title: Parent-reported symptoms may not be adequate to define asthma control in children.
abstract: BACKGROUND
  Asthma guidelines have suggested that treatment decisions should be guided by indices of asthma control and not only by disease severity. In adults, symptom-based asthma control parameters have been shown to predict exacerbations and health care services use (HSU). We hypothesize that defining asthma control using parent-reported symptoms alone is not adequate in children.
  
  
  METHODS
  Cross-sectional data from the population-based asthma in Canada study were reanalyzed. Random-digit dialing was used to produce the final sample, consisting of 1,001 asthmatics: 801 adults (aged 16+) and 200 children (aged 4-15) participating by parental proxy. Weighted frequencies of Canadian guideline defined asthma control parameters, perceived asthma control, HSU and medication use were calculated separately for adults and children. Stratified analyses compared HSU in controlled versus uncontrolled asthmatics.
  
  
  RESULTS
  Over 90% of parents of asthmatic children believed their child's asthma to be controlled. Only 45% were actually controlled as defined by guideline parameters. Among controlled asthmatics, children reported higher HSU (32% reported 2+ health care encounters versus 17% of adults, P < 0.001). Irrespective of control and despite similar use of controller therapy, children reported a higher number of health care encounters than adults (any emergency department visits 37% vs. 24%, P = 0.00003; unscheduled doctor visits 59% vs. 36%, P < 0.00001). While reporting higher HSU, asthmatic children had less frequent episodes of excessive daytime symptoms than adults (29% vs. 49%, respectively, P < 0.0001).
  
  
  CONCLUSIONS
  Current symptom-based asthma control parameters reported by parental proxy are likely poor predictors of asthma HSU and may not provide adequate asthma control estimates in children.
authors.affiliation: Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. sharon.dell@sickkids.ca
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Dell
authors.forename: Richard
authors.initials: R
authors.lastname: Foty
authors.forename: Allan
authors.initials: A
authors.lastname: Becker
authors.forename: Edmee
authors.initials: E
authors.lastname: Franssen
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Chapman
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010287:Parent-Child Relations; D035622:Parental Notification; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires