ATLANTA – For low-income and minority children with asthma, parents’ perception of a child’s asthma control may be an important predictor of future acute visits, independent of guideline-based criteria for asthma control, judging from the results from a prospective cohort study.

The National Asthma Education and Prevention Program (NAEPP)–based assessment of asthma control incorporates symptoms, nighttime awakenings, and activity interference; short-acting beta 2-agonist use, lung function, and history of exacerbations, “but it does not take into account parental perceptions of asthma control,” lead study author Suzanne Rossi, MD, said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We also know that parental report of symptom frequency and their perception of their child’s asthma control are frequently discordant.”

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This prompted Dr. Rossi and her associates in the division of pediatric allergy and immunology at Johns Hopkins University, Baltimore, to investigate the following question: Does parental perception of asthma control predict future acute asthma–related health care use, independent of NAEPP-based asthma control, among a population of low-income and minority children with asthma? A secondary question they set out to answer was whether age, gender, or body mass index modify the effect of parental perception of asthma control on future acute visits. “We felt this was an important question, because asthma morbidity varies by age and gender, and childhood obesity is associated with an increased risk of worse asthma control and exacerbation,” Dr. Rossi said.

In an effort to answer these questions, the researchers conducted a prospective cohort study of 150 Baltimore children aged 5-17 years with persistent asthma who had an exacerbation within the past year. After a baseline assessment, clinic visits occurred every 3 months for 1 year. The predictor variable was parental perception of asthma control assessed by the following question: “Do you believe that your child’s asthma was well controlled within the past 4 weeks?” The primary outcome was an acute visit, defined as an unscheduled visit to a physician or an ED visit or a hospitalization. The researchers used generalized estimating equations to relate parental perception of asthma control to future acute visits.

The mean age of patients was 11 years, 57% were male, 91% were African American, and 85% were on public health insurance. In addition, 15% were overweight and 28% were obese. At baseline, patients were using short-acting beta-2 agonists a mean of 4.2 days every 2 weeks, and 96% had an acute visit in the prior 12 months. Only 9% met criteria for well-controlled asthma as defined by NAEPP criteria, 36% were not well controlled, and 55% were poorly controlled.

At the baseline visit, 73% of parents said that their child’s asthma was well controlled, 20% said that it was not well controlled, and 7% were unsure. Of the 136 children who met NAEPP criteria for uncontrolled asthma, 71% had parents who reported that their child’s asthma was well controlled.

The researchers found that on average, children with parents who report uncontrolled asthma were 2.4-fold times more likely to have an acute visit within the next 3 months, compared with children whose parents reported that their child’s asthma was well controlled. The odds ratio remained similar after adjustment for NAEPP-based asthma control, and for age, gender, race, controller medication, insurance, and atopy. Data on hospitalization was excluded because there was insufficient data for analysis.

Dr. Rossi and her associates also found that parental perception of uncontrolled asthma was a predictor of future acute visits among females but not males (odds ratio, 5.3 vs. OR, 1.3, respectively; P = .03), and among those who were overweight or obese but not among those with a normal BMI (OR, 6.2 vs. OR, 1.3; P = .04). Age was not a modifier. She acknowledged certain limitations of the study, including the inability to measure the severity of asthma exacerbation. “Therefore, this primary outcome may reflect parental concern,” Dr. Rossi said. “In addition, these findings may not be generalizable to other pediatric asthma populations. We also had a small sample size for some outcomes such as hospitalization. In terms of future directions, it would be nice to know whether the findings are replicable in other similar populations and in population-based studies. It would be interesting to examine the association with larger study populations to evaluate hospitalizations and to get an assessment of the severity of symptoms associated with the acute visit.”

The National Institute of Allergy and Infectious Diseases, the National Institute of Environmental Health Sciences, and Johns Hopkins University School of Medicine supported the study. Dr. Rossi reported having no financial disclosures.

dbrunk@frontlinemedcom.com

Parental perception of asthma may predict future acute visits