Elizabeth L. McQuaid, Ph.D. (1), Gregory K. Fritz, M.D (1)., Robert B. Klein, M.D. (1),
Daphne Koinis Mitchell, Ph.D. (1), Sheryl J. Kopel, M.Sc. (1), Jack H. Nassau, Ph.D. (1),
Natalie Walders, Ph.D. (2), Marianne Z. Wamboldt, M.D. (3)
(1) Rhode Island Hospital and Brown Medical School, Providence, RI USA
(2) National Jewish Medical and Research Center, Denver, CO USA
(3) The Children's Hospital, Denver, CO USA
Poorly controlled asthma is critical problem in pediatrics. Individual factors (e.g., symptom perception) and the family approach to asthma management may influence outcomes. The present study assessed the direct and indirect contributions of symptom perception and family management to pediatric asthma morbidity.
One hundred ten children with asthma (47% female, ages 7-17) and their caretakers participated. Symptom perception was assessed over five weeks using a programmable electronic spirometer that prompted children to guess their PEFR prior to objective measurement.
Peak flow blows were classified into zones of accuracy (AZ), danger (DZ), or symptom magnification (SMZ) by use of an error grid (Klein et al., 2004).
A semi-structured interview (FAMSS; Klinnert et al., 1997) was conducted to assess family asthma management. Asthma morbidity was assessed by questionnaire. Analyses controlled for severity.
Results demonstrated that the proportion of blows in each of the grid zones was linked to morbidity (AZ R2 = 10%; DZ R2 = 4%, SMZ R2 = 5%, all p's < .05).
Family asthma management was also associated with morbidity, ( R2 = 19%, p < .001). Regression analyses indicated that family asthma management mediated the association between dangerous symptom perception (i.e. proportion of DZ blows) and morbidity. Accurate symptom perception and symptom magnification remained associated with morbidity when family asthma management was taken into account.
Individual and family factors influence pediatric asthma morbidity.
The relationship between symptom perception and family strategies may be most relevant when children underestimate the symptom severity.