Subjective symptom perceptual accuracy in asthmatic children and their parents in India

doi:10.1016/S1081-1206(10)60939-8

Annals of Allergy, Asthma & Immunology

Volume 97, Issue 4, October 2006, Pages 484-489

https://doi.org/10.1016/S1081-1206(10)60939-8 Get rights and content

Background

Inaccurate symptom perception is a key factor in increased morbidity and mortality in asthmatic patients. Information is sparse on whether children and their parents can accurately perceive severity of symptoms.

Objective

To determine symptom perceptual accuracy in children with asthma and either of their parents.

Methods

Fifty-two asthmatic children and either of their parents recorded independently, for 2 weeks, subjective evaluation of the child's symptoms on a 100-mm visual analog scale (VAS). Peak expiratory flow (PEF) was used as an objective measurement. Both VAS and PEF data were graded into green, yellow, and red zones. The 2 sets of VAS zones (children and parents) were separately matched with PEF zones to determine perceptual accuracy.

Results

Children and parents were accurate more than half of the time (60% and 62%, respectively), but accuracy decreased when the “child was unstable” (PEF <80% of personal best), with underestimation being significant (P < .001). Among the readings obtained, underestimation of severity of symptoms was significant in children with severe asthma (125 [45%] of 278 readings), those affected by environmental tobacco smoke (130 [24%] of 532), and those in the younger age group (127 [45%] of 280). Underestimation was significantly greater when PEF readings were in the yellow zone (P < .001).

Conclusions

Symptom perception by children was as reliable as that by their parents. However, parents and children tended to underestimate severity when the child was unstable. An early decline in PEF readings was missed by children and their parents, which could contribute to increased morbidity and mortality in this vulnerable age group.

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Cited by (10)

Adolescents' Perception of Asthma Symptoms and Health Care Utilization
2011, Journal of Pediatric Health Care
Pediatric asthma is accountable for a substantial use of health care services. The purpose of this study was to systemically examine the extent to which inaccurate perception of asthma symptoms is associated with the use of health care services.
This exploratory study included 126 adolescents with asthma who were between 13 and 20 years of age. Subjects were classified as having inaccurate symptom perception (IG); well-controlled accurate symptom perception (WCA); and poorly controlled accurate symptom perception (PCA). These groups were compared with respect to health care utilization, including emergency department (ED) visits, hospitalization, and office visits and school absenteeism in the past 3 months.
More adolescents in the IG group had at least one hospitalization compared with adolescents in the PCA or WCA groups (23.1% vs. 11.1% vs. 2.6%, respectively). A similar trend was seen for ED visits. Compared with the WCA group, adolescents in the IG group were nearly nine times more likely to have been hospitalized, 3.4 times more likely to have visited an ED, and four times more likely to have missed school days.
Adolescents with inaccurate symptom perception are more likely to have hospitalizations, ED visits, and missed days from school compared with those who have accurate perceptions. The findings underscore the importance of screening for perceptual accuracy of asthma symptoms and call for interventions promoting accurate symptom assessment in adolescents with asthma to ensure appropriate care.
Parent-Child Agreement in Report of Nighttime Respiratory Symptoms and Sleep Disruptions and Quality
2009, Journal of Pediatric Health Care
Citation Excerpt :
Parent-child concordance rates in this study were symptom specific rather than generalized as high or low. This finding is similar to what others have suggested for report of daytime symptoms (Braun-Fahrlander et al., 1998; Fritz, McQuaid, Spirito, & Klein, 1996; Horak, Grassl, Skladal, & Ulmer, 2003; Lara et al., 1998; Mittal et al., 2006; Renzoni et al., 1999). Parents and children can be taught symptom-specific identification skills, such as wheezing (Lee, Arroyo, & Rosenfeld, 1996), and this can be a focus of educational efforts, especially if the child has moderate-severe symptoms, where inaccurate appraisal has had the greatest negative impact on control assessments (Halterman et al., 2006).
Asthma control requires assessment of nighttime symptoms and sleep disruption. Cognitive and emotional development enables most school-aged children to report nocturnal problems, but providers often rely only on parental report, potentially limiting the comprehensiveness of their assessments and their ability to support the child's emerging efforts at shared management of their illness. This study investigated parent-child concordance in report of nighttime respiratory symptoms, sleep disruption, and quality of sleep in a sample of 9- to 11-year-old children with asthma. Secondarily, similar concordance patterns in an equal number of dyads where the child was asthma free were examined to illustrate the potential influence of asthma.
Parents and children completed 1-week diaries in their homes without confiding in one another. The probability of knowing the child's report on a specific item if the parent's report was known was assessed using contingency tables.
Within the asthma group, parent-child reports differed significantly across all symptoms and sleep parameters. Parents most often reported fewer symptoms and awakenings and better quality of sleep than did their child. Concordance rates were lowest for morning perceptions of tiredness, sleepiness, and alertness in both asthma and non-asthma groups.
Both parents and school-aged children with asthma need to be asked about nighttime asthma symptoms, sleep, and morning perceptions when attempting to evaluate asthma control. Assessment of sleep in all children should include parent and child reports and would benefit by the addition of objective measures.
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2018, Respiratory Research
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2017, Allergy, Asthma and Clinical Immunology
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ORIGINAL ARTICLESSubjective symptom perceptual accuracy in asthmatic children and their parents in India

Background

Objective

Methods

Results

Conclusions

J Am Acad Child Adolesc Psychiatry

J Allergy Clin Immunol

Global Strategy for Asthma Management and Prevention

Poorly perceived asthma [editorial]

Thorax

Symptom perception in asthma: a multidisciplinary review

J Asthma

NHLBI workshop summary: symptom perception and respiratory sensation in asthma

Am J Respir Crit Care Med

Symptom perception and evaluation in childhood asthma

Nurs Res

Poor perception of airway obstruction in children with asthma

J Asthma

ORIGINAL ARTICLES
Subjective symptom perceptual accuracy in asthmatic children and their parents in India