title: Patient factors used by pediatricians to assign asthma treatment.
abstract: OBJECTIVE
  Although asthma is often inappropriately treated in children, little is known about what information pediatricians use to adjust asthma therapy. The purpose of this work was to assess the importance of various dimensions of patient asthma status as the basis of pediatrician treatment decisions.
  
  
  METHODS
  We conducted a cross-sectional, random-sample survey, between November 2005 and May 2006, of 500 members of the American Academy of Pediatrics using standardized case vignettes. Vignettes varied in regard to (1) acute health care use (hospitalized 6 months ago), (2) bother (parent bothered by the child's asthma status), (3) control (frequency of symptoms and albuterol use), (4) direction (qualitative change in symptoms), and (5) wheezing during physical examination. Our primary outcome was the proportion of pediatricians who would adjust treatment in the presence or absence of these 5 factors.
  
  
  RESULTS
  Physicians used multiple dimensions of asthma status other than symptoms to determine treatment. Pediatricians were significantly more likely to increase treatment for a recently hospitalized patient (45% vs 18%), a bothered parent (67% vs 18%), poorly controlled symptoms (4-5 times per week; 100% vs 18%), or if there was wheezing on examination (45% vs 18%) compared with patients who only had well-controlled symptoms. Pediatricians were significantly less likely to decrease treatment for a child with well-controlled symptoms and recent hospitalization (28%), parents who reported being bothered (43%), or a child whose symptoms had worsened since the last doctor visit (10%) compared with children with well-controlled symptoms alone.
  
  
  CONCLUSIONS
  Pediatricians treat asthma on the basis of multiple dimensions of asthma status, including hospitalization, bother, symptom frequency, direction, and wheezing but use these factors differently to increase and decrease treatment. Tools that systematically assess multiple dimensions of asthma may be useful to help further improve pediatric asthma care.
authors.affiliation: Department of Pediatrics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21287-0005, USA. sandeokelo@jhmi.edu
authors.forename: Sande O
authors.initials: SO
authors.lastname: Okelo
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Patino
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riekert
authors.forename: Barry
authors.initials: B
authors.lastname: Merriman
authors.forename: Andrew
authors.initials: A
authors.lastname: Bilderback
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Hansel
authors.forename: Kathy
authors.initials: K
authors.lastname: Thompson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thompson
authors.forename: Ruth
authors.initials: R
authors.lastname: Quartey
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians'
chemical_list: D018927:Anti-Asthmatic Agents