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How Do Perceptions of Asthma Control and Severity Relate to Indicators of Asthma Status and Treatment Recommendations

Seifu Demissie, Kristin A Riekert, Michelle N Eakin

    Pediatric Allergy, Immunology, and Pulmonology
    |March 29, 2012
    PubMed

    Insights

    Pediatricians use asthma control ratings to step up treatment, but consider both control and severity when stepping down therapy. This impacts how pediatricians manage childhood asthma effectively.

    Area of Science:

    • Pediatric Pulmonology
    • Asthma Management
    • Clinical Practice Research

    Background:

    • National Institutes of Health (NIH) guidelines differentiate asthma control and severity.
    • Pediatrician understanding and application of these distinct constructs in clinical practice remain unclear.
    • The influence of control and severity distinctions on pediatric asthma treatment recommendations is not well-established.

    Purpose of the Study:

    • To investigate how pediatricians differentiate asthma control and severity in clinical decision-making.
    • To determine the impact of specific asthma indicators on pediatrician ratings of control and severity.
    • To examine how pediatrician ratings of asthma control and severity influence treatment recommendations.

    Main Methods:

    • A survey of 270 pediatricians using patient vignettes with varying asthma indicators was conducted.
    • Pediatricians rated asthma control and severity using a visual analog scale (VAS).
    • Regression models analyzed the association between asthma indicators, control/severity ratings, and treatment recommendations.

    Main Results:

    • Frequent symptoms and recent hospitalization significantly influenced both control and severity ratings.
    • Wheeze and parental report of bother primarily affected control ratings.
    • Poorer asthma control ratings, not severity, predicted stepping up treatment; both control and severity influenced stepping down treatment.

    Conclusions:

    • Pediatricians' decisions to escalate asthma therapy are primarily driven by assessed asthma control.
    • The decision to de-escalate asthma therapy involves consideration of both asthma control and severity.
    • Clarifying these distinctions can refine asthma management guidelines and improve pediatric care.

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