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Child asthma severity misjudged

By Christian Duffin

GPs should not rely on parental assessments of childhood asthma as they systematically under-estimate the severity of symptoms, a new study warns.

The researchers found unstructured assessments missed key symptoms and stressed the importance of formally evaluating children.

In the US study, parents who were asked to monitor their child's asthma day and night ­ including use of rescue medication and restrictions on activities ­ rated symptoms as far less severe than researchers using structured assessments.

Among parents of 87 children who researchers rated to have moderate or severe persistent asthma, 67 per cent agreed or strongly agreed their child's asthma was well-controlled.

Nearly half of the same parents said their children experienced 'mild symptoms once in a while' or 'mild symptoms frequently'.

When asked to rate severity from 'no symptoms' to 'very bad', 41 per cent of parents grossly overestimated their child's well-being. These

'critical errors' were as common in affluent families as poor ones and were not influenced by a child's age or maintenance medication use (see box, right).

Dr Jill Halterman, assistant professor of paediatrics at the University of Rochester in New York, said: 'We found all unstructured methods of assessment underestimate severity. It is possible educating families and professionals about these discrepancies may help improve asthma symptom assessments in the future.'

Professor David Price, professor of respiratory care medicine at the University of Aberdeen, said: 'Children feel embarrassed about asthma and don't tell their parents everything. It's tempting for GPs to ask parents, but they should be asking the children themselves.'

Professor Price added: 'Parents don't always notice that their child plays in goal rather than centre-forward to avoid more strenuous exercise.'

Dr Hilary Pinnock, a GP in Whitstable, Kent, and member of the General Practice Airway Group general committee, said: 'GPs need to ask specific questions about sleeping and exercise, for example.'

The study was published online by Archives of Disease in Childhood.

Asthma errors

Percentage of parents who made 'critical errors' in assessing

their child's asthma

Socio-economic status

Poor 43.1

Non-poor 38.9

Maintenance medication

Yes 38.7

No 48.0

Age of child

5-8 years 37.1

9-12 years 44.2

Asthma severity

Moderate persistent 49.1

Severe persistent 28.1

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