Mismatch between asthma symptoms and spirometry: implications for managing asthma in children

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Assessment

Background:

• Asthma management in children relies on accurate severity assessment.
• General pediatricians utilize clinical criteria and patient-reported symptoms.
• Spirometry is a key tool for objective lung function measurement.

Purpose of the Study:

• To evaluate the concordance between spirometry and clinical assessment of asthma severity in children.
• To determine if clinical assessment aligns with spirometry findings in guiding pediatric asthma therapy.

Main Methods:

• 894 children (ages 5-19) with pediatrician-assessed asthma severity underwent spirometry.
• Asthma severity was classified using national guidelines.
• Weighted Kappa coefficients were used to compare concordance between clinical and spirometry-determined severity.

Main Results:

• 36% of children had lower clinically determined asthma severity compared to spirometry.
• The overall concordance between clinical assessment and spirometry was low (Kappa=0.16-0.20).
• Spirometry-determined severity was a significant predictor of agreement, with worse agreement at higher severity levels.

Conclusions:

• There is a low level of agreement between spirometry and clinical assessment for pediatric asthma severity.
• Spirometry results may provide a more objective basis for guiding asthma therapy decisions in children.
• Improved objective assessment can lead to better asthma morbidity reduction.