2013 http://informahealthcare.com/jas ISSN: 0277-0903 (print), 1532-4303 (electronic) J Asthma, 2013; 50(9): 1002–1009 ! 2013 Informa Healthcare USA, Inc. DOI: 10.3109/02770903.2013.822082 EDUCATION Asthma knowledge, subjective assessment of severity and symptom perception in parents of children with asthma Cla ´udia Mendes Silva, MA 1 and Luı ´sa Barros, PhD 2 1 Department of Psychology and Education, University of Beira Interior, Covilha ˜, Portugal and 2 Faculty of Psychology, University of Lisbon, Lisbon, Portugal Abstract Objectives: This study aimed to confirm the tendency for parents to underestimate the severity of symptoms and the poor consistency between parents’ reports of symptoms and the physicians’ evaluation of asthma control. Additionally, the relationship between parents’ asthma knowledge and their report of symptoms and estimation of asthma severity was explored. Methods: Fifty children (M ¼ 10.5 years) and their caregivers were recruited from two Portuguese hospitals. A measure of asthma symptoms report (Severity of Chronic Asthma, SCA) and a subjective evaluation of asthma severity were collected and compared with physicians’ ratings of asthma control, as well as parents’ knowledge about asthma (Asthma Knowledge Questionnaire, AKQ) and emotional disturbance (Brief Symptom Inventory, BSI). Results: Although parents’ evaluation of perceived asthma severity was moderately correlated to symptoms reported, results confirm an inconsistency between parents’ reports of symptoms, their subjective rating of asthma severity and the physician’s rating of clinical control, revealing a tendency for parents to underestimate disease severity and to underreport asthma symptoms. Asthma knowledge was not significantly correlated to SCA or to parents’ subjective evaluation of asthma severity. Parents with poorer knowledge reported fewer symptoms. Conclusions: Portuguese parents revealed a tendency to overestimate their child’s level of asthma control and a low level of asthma knowledge. Parents’ education, psychological disturbance and time since diagnosis were associated with asthma knowledge. Parents’ knowledge was not related to the child’s asthma outcomes or to their subjective evaluation of asthma severity or symptoms reports. Parents’ asthma knowledge deficits, underreporting of symptoms and underestimation of asthma severity, may affect parent–provider communication and impede asthma control. Keywords Asthma control, Brief Symptom Inventory, caregivers, child’s asthma, disease knowledge, perceived severity, symptoms reports History Received 22 March 2013 Revised 24 June 2013 Accepted 30 June 2013 Published online 9 August 2013 Introduction Asthma is one of the most common chronic diseases in children, and its prevalence is increasing in developed countries [1–3]. Asthma is associated with high morbidity, leading to a high rate of emergency department visits, and is the most common cause of hospitalization in chronically ill children in Portugal [4,5]. There is a considerable variation in asthma symptoms over time, with different daily and seasonal symptom patterns, and among individuals. Even in mild cases, both the symptoms and the treatments interfere with the daily activities of patients and their families [6,7]. Asthma management should include a comprehensive treatment plan that incorporates preventive actions (avoidance of allergens and triggers), appropriate pharmacotherapy, particularly anti-inflammatory agents, and asthma education programmes for patients and parents [8]. The ultimate goal of this treatment plan is to achieve long-term asthma control. Childhood asthma control is largely affected by family factors, such as family asthma management strategies [9,10]. The highly variable nature of asthma symptoms implies that parents need to closely monitor symptoms and make asthma management decisions and actions on a daily basis [8,11]. Effective care also requires that caregivers accurately report the pattern of symptoms and medication use to physicians. Treatment for asthma is usually guided by patients’ perceptions of their symptoms [12–14]. Research has revealed a low accuracy rate in the perception of asthma severity, both in adult patients and in parents of paediatric patients [15,16]. Yoos et al. [14] studied the accuracy of parent’s and children’s reports on asthma and found that more than one-third of families made clinically significant errors in judging symp- tom severity. In addition, Stout et al. [17] confirmed that relying only on symptom frequency, to classify asthma severity, underestimates the number of children with moder- ate-to-severe persistent asthma. Inaccurate symptom perception has also been identified as a contributing factor to asthma morbidity, as it hinders Correspondence: Cla ´udia Mendes Silva, Department of Psychology and Education, University of Beira Interior, Estrada do Sineiro, 6200-209 Covilha ˜, Portugal. E-mail: cmsilva@ubi.pt J Asthma Downloaded from informahealthcare.com by 85.138.132.188 on 11/04/13 For personal use only.