AMBULATORY PEDIATRICS Volume 3, Number 2 102 Copyright  2003 by Ambulatory Pediatric Association March–April 2003 A Potential Pitfall in Provider Assessments of the Quality of Asthma Control Jill S. Halterman, MD, MPH; Kenneth M. McConnochie, MD, MPH; Kelly M. Conn, BS; H. Lorrie Yoos, PhD; Jeffrey M. Kaczorowski, MD; Robert J. Holzhauer, MD; Marjorie Allan, BS; Peter G. Szilagyi, MD, MPH Background.—Pediatricians elicit information about asthma control from parents to help formulate management plans. If parents of children with significant asthma symptoms inappropriately indicate good control, physician recommenda- tions may not be optimal. We examined whether a single general question about asthma control might lead to inaccurate assessment of severity. Design/Methods.—Children 3–7 years of age who met the National Heart, Lung, and Blood Institute (NHLBI) criteria for mild persistent to severe asthma were identified from 40 urban schools. A phone survey of their parents provided demographic information, symptom frequency, medication use, and general interpretation of their child’s asthma control. Chi-square analyses compared the parent’s general interpretation of control with demographic characteristics and mea- sures of asthma severity. Results.—One hundred sixty of 224 eligible children participated in this study. Seventy-eight percent were described as in good asthma control. General assessment of asthma control did not vary by demographic characteristics. Parents were as likely to describe children with daily asthma symptoms in good control as they were to describe children with less frequent symptoms in good control. Parents were less likely to report good control in children using daily rescue medications when compared with children with less frequent medication use (65% vs 82%, P = .03), but the majority of children in both groups was described as having good control. Conclusions.—Most parents underestimated the severity of their child’s asthma and reported good control with their global assessment. Parents frequently reported good control even when the children had daily asthma symptoms. Pe- diatricians should ask about specific asthma symptoms during patient encounters because a global question about asthma control likely will result in underestimations of asthma severity. KEY WORDS: childhood asthma; inner city; parents; symptoms Ambulatory Pediatrics 2003;3:102 105 A sthma is the most common chronic disease of childhood, affecting almost 5 million children in the United States. 1,2 While national guidelines rec- ommend daily preventive medications for all children with mild persistent to severe asthma, 3 several studies in- dicate that many children who should receive these med- ications are not receiving them. 4–6 Further, poor children suffer the largest burden of asthma morbidity 7–11 and are more likely than nonpoor children to receive inadequate preventive therapy. 12–16 Several studies have addressed potential causes for de- ficient preventive therapy for asthma, including patient From the Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children’s Re- search Center, Rochester, NY (Dr Halterman, Dr McConnochie, Ms Conn, Dr Kaczorowski, Dr Holzhauer, Ms Allan, and Dr Szilagyi); and the School of Nursing (Dr Yoos), University of Rochester School of Medicine and Dentistry, Rochester, NY. Address correspondence to Jill S. Halterman, MD, MPH, Uni- versity of Rochester School of Medicine, Box 777, Golisano Chil- dren’s Hospital at Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY 14642 (e-mail: jillhalterman@urmc.rochester.edu). This work was supported by a grant from the Halcyon Hill Foun- dation. Received for publication July 1, 2002; accepted November 11, 2002. factors, 17–19 physician factors such as lack of familiarity or agreement with guidelines, 20–22 and communication barri- ers. 19,23,24 We recently found among a group of poor urban children with mild persistent to severe asthma that clini- cians frequently underestimated the child’s symptom se- verity and subsequently did not prescribe preventive med- ications. 25 This was true even for children with significant asthma symptoms who had been seen by their health care provider in the prior 6 months. Pediatric health care providers often depend on the par- ents’ assessment of their child’s asthma control to for- mulate a management plan. With increasing time pres- sures in a managed care environment, clinicians likely of- ten ask an open ended question (eg, ‘‘Do you feel your child’s asthma is under good control?’’ or ‘‘How is your child’s asthma?’’) and follow up with detailed, specific queries only if the parent asserts at this critical moment that control is not good. Thus, this study was constructed to determine how parents respond to a single general question about the status of their child’s asthma. If parents respond with a message reflecting good asthma control, even for their children with significant symptoms, the physician may fail to identify these ill children and the opportunity to improve asthma control through preventive medications might be missed. We hypothesize that a general question about asthma