title: Classifying asthma severity: objective versus subjective measures.
abstract: National guidelines recommend the use of clinical history and spirometry to determine asthma severity. We examined the usefulness of the six guideline-recommended clinical questions in determining asthma severity and then compared guideline-determined severity to clinician-reported and spirometry-determined severity in a cross-sectional study of 201 children with asthma who were not receiving controller therapy. Four guideline-recommended questions (daytime and nocturnal symptoms, school absenteeism, and exercise impairment) determined asthma severity. Concordance between clinician-reported and spirometry-determined asthma severity was poor (kappa = 0.02). Clinical history alone underestimated spirometry-determined disease severity in 27% of children while spirometry results alone underestimated clinician-determined severity in 40% of children.
authors.affiliation: Asthma Center, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Cowen
authors.forename: Dorothy B
authors.initials: DB
authors.lastname: Wakefield
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cloutier
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001249:Asthma / Q000145:classification* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013147:Spirometry