Reported Asthma Control Predicts Future Visits, Independent of Guideline-Based Control Measures

This study assessed how a caregiver’s perception of their child’s asthma control might impact the child’s risk for having future urgent visits for asthma care.

Two cohorts of low income, ethnic minority children in Baltimore or Boston from the Mouse Allergen and Asthma Cohort Study (MAACS) and the Mouse Allergen and Asthma Intervention Trial (MAAIT) with persistent asthma, aged 5 to 17 years were included. The MAACS study correlated mouse exposure with asthma features, while the MAAIT study evaluated pest control education and management on asthma morbidity.

Subjects were given surveys at baseline and quarterly for one year to assess for symptoms, bronchodilator use, urgent visit frequency, and asthma control. Guideline-based asthma control was assessed with the National Asthma Education and Prevention Program (NAEPP) tool. Caregiver assessment was analyzed in comparison with future acute visits at each quarterly interval. Acute visits were defined as a composite of emergency department visits, hospitalizations, and unscheduled doctor’s visits in this study.

Subjects were primarily Black (79% to 91%) and had public health insurance (85% to 88%). Discordance was noted between NAEPP guideline (GA) and caregiver (CA)-based assessment of asthma; about half of the subjects had very poorly controlled asthma (as described by NAEPP, 47% to 50%), while about one third of parents rated their child’s asthma as uncontrolled (27% to 31%). Patients with CA poorly controlled asthma were more likely to have increased acute visits in the following quarter as compared with children who had CA controlled asthma (odds ratio [OR], 1.7–2.4). This increased risk persisted when controlling for guideline-based control assessment, age, sex, race, insurance type, maintenance medications, and other atopic conditions (OR, 1.5–2.4).

CA asthma control among socioeconomically disadvantaged children may predict a child’s risk for an urgent visit in subsequent months. CA of asthma control might provide information that is independent of control measures based on national guidelines.

This study provides evidence to support the importance of CA of asthma control in predicting a child’s risk of an unscheduled medical visit. Previous studies have shown that GA does not adequately predict subsequent control. In this study, NAEPP GA of asthma control was less-significantly associated with future acute visits. Future studies should test tools that incorporate CA of control into management algorithms to complement current practices. A child’s perception of their own asthma control is another likely complementary vantage-point to be included in future studies.