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Limitations of questioning asthma to assess asthma control in general practice
Wanda Hagmolen Of Ten Have1, Norbert J van den Berg, Job van der Palen
1Medical Spectrum Twente, Department of Pulmonology, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands. wandahoth@hotmail.com
Insights
Many children with asthma are misdiagnosed as controlled because they do not report symptoms. Assessing airway hyperresponsiveness is recommended for better asthma management in primary care.
Area of Science:
- Pediatric Pulmonology
- Primary Care Medicine
- Asthma Management
Background:
- Current asthma monitoring in primary care relies on symptom frequency.
- The adequacy of symptom-based assessment for identifying uncontrolled asthma in children is questioned.
Purpose of the Study:
- To demonstrate that some children with asthma are incorrectly classified as controlled.
- To highlight that a lack of reported symptoms can mask uncontrolled asthma.
Main Methods:
- Study included 119 children with recent wheezing and moderate to severe airway hyperresponsiveness.
- Analysis focused on whether these children reported current asthma symptoms during routine visits.
Main Results:
- 18% of children lacked current asthma symptoms despite airway hyperresponsiveness and recent wheezing.
- Poor adherence to controller medication was observed in the study group.
Conclusions:
- General practitioners lack sufficient tools for accurate asthma control assessment in children.
- Incorporating airway hyperresponsiveness testing is recommended for improved asthma management in primary care.
- This approach can lead to better overall asthma control in pediatric patients.
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.
Aim:
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.
Patients And 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.
Conclusion:
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.
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