Limitations of questioning asthma to assess asthma control in general practice.
BACKGROUND
The monitoring of children with asthma in primary care is based on the occurrence and frequency of asthma symptoms. We questioned whether the current approach is adequate to identify all children in whom a sufficient level of asthma control is not achieved.


OBJECTIVE
The aim of this study is to illustrate that in some children asthma was incorrectly considered controlled, because the children failed to report current symptoms of asthma.


METHODS
One hundred and nineteen children were identified with recent wheezing plus moderate or severe airway hyperresponsiveness. We analyzed whether these children reported current symptoms of asthma (as normally questioned during a routine visit).


RESULTS
In 20 children (18%) current asthma symptoms were absent despite moderately or severe airway hyperresponsiveness and wheezing in the last year. In addition, the usage of controller medication was very poor.


CONCLUSIONS
We conclude that the general practitioner has insufficient tools to adequately assess asthma control in all children. The assessment of airway hyperresponsiveness as an additional guide to manage asthma in children in general practice is recommended. In this way, better asthma control can be achieved.
Medical Spectrum Twente, Department of Pulmonology, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands. wandahoth@hotmail.com
Wanda
W
Hagmolen Of Ten Have
Norbert J
NJ
van den Berg
Job
J
van der Palen
Wim M C
WM
van Aalderen
Patrick J E
PJ
Bindels
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000188:drug therapy / Q000503:physiopathology; D002648:Child; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D010366:Peak Expiratory Flow Rate; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods; D012135:Respiratory Sounds / Q000187:drug effects / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents