title: Mismatch between asthma symptoms and spirometry: implications for managing asthma in children.
abstract: OBJECTIVE
  To examine the concordance between spirometry and asthma symptoms in assessing asthma severity and beginning therapy by the general pediatrician.
  
  
  METHODS
  Between 2008 and 2012, spirometry testing was satisfactorily performed in 894 children (ages 5-19 years) whose asthma severity had been determined by their pediatrician using asthma guideline-based clinical criteria. Spirometry-determined asthma severity using national asthma guidelines and clinician-determined asthma severity were compared for concordance using weighted Kappa coefficients.
  
  
  RESULTS
  Thirty percent of participants had clinically determined intermittent asthma; 32%, 33%, and 5% had mild, moderate, and severe, persistent asthma, respectively. Increasing disease severity was associated with decreases in the forced expiratory volume in 1 second/forced vital capacity (FVC) ratio (P < .001), the forced expiratory volume in 1 second/FVC% predicted (P < .0001), and the FVC% predicted (P < .01). In 319 children (36%), clinically determined asthma severity was lower than spirometry-determined severity. Concordance was 0.16 (95% CI 0.10, 0.23), and when adjusted for bias and prevalence, was 0.20 (95% CI 0.17, 0.23). When accounting for age, sex, exposure to smoke, and insurance type, only spirometry-determined asthma severity was a significant predictor of agreement (P < .0001), with worse agreement as spirometry-determined severity increased.
  
  
  CONCLUSIONS
  Concordance between spirometry and asthma symptoms in determining asthma severity is low even when guideline-based clinical assessment tools are used. Because appropriate therapy reduces asthma morbidity and is guided by disease severity, results from spirometry testing could better guide pediatricians in determining appropriate therapy for their patients with asthma.
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Schifano
authors.affiliation: Department of Pediatrics, School of Medicine, University of Connecticut Health Center, Connecticut Children's Medical Center, Hartford, CT.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Hollenbach
authors.affiliation: Department of Pediatrics, School of Medicine, University of Connecticut Health Center, Connecticut Children's Medical Center, Hartford, CT. Electronic address: mclouti@connecticutchildrens.org.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cloutier
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013147:Spirometry / Q000379:methods*; D014797:Vital Capacity; D055815:Young Adult