To examine the concordance between spirometry and asthma symptoms in assessing asthma severity and beginning therapy by the general pediatrician.

All children with asthma who were 5 to 19 years of age and were referred to the Spirometry and Aeroinhalant Allergy Testing Clinic at Connecticut Children’s Medical Center between 2008 and 2012 by a clinician participating in a study were eligible for inclusion.

Spirometry testing was satisfactorily performed in 894 children whose asthma severity had been determined by their pediatrician using asthma guideline–based clinical criteria. Spirometry-determined asthma severity using national asthma guidelines and clinician-determined asthma severity were compared for concordance using weighted κ coefficients.

Thirty percent of participants had clinically determined intermittent asthma; 32%, 33%, and 5% had mild, moderate, and severe, persistent asthma, respectively. Increasing disease severity was associated with decreases in the forced expiratory volume in 1 second/forced vital capacity (FVC) ratio (P < .001), the forced...

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