The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Symptom Variability in Children and Adults with Persistent Asthma: A Survey of Adult Patients and Pediatric Patients’ Caregivers

L DePrisco, RRT,1 P Marcus, MD, MPH,1 KR Murphy, MD,2 A Rahman,3 CD O’Brien, MD, PhD.3 1New York College of Osteopathic Medicine, Old Westbury, NY, 2Midwest Children’s Chest Physicians, Omaha, NE, 3AstraZeneca LP, Wilmington, DE

BACKGROUND: To address the variability of asthma symptoms, current national and international asthma treatment guidelines recommend a stepwise approach to pharmacologic intervention, in which periodic adjustments in treatment are recommended according to changes in asthma severity.
This study surveyed adult asthma patients and caregivers of children with asthma to assess the variability of symptoms in pediatric and adult patients.

METHODS: 23 888 prospective participants were selected from a US database of nearly 200 000 patients with asthma and invited to complete an Internet-based survey. Caregivers of pediatric patients aged 6 to 18 years and identified as having persistent asthma for at least 1 year and adult patients aged 18 years or older and diagnosed with asthma for at least 1 year were eligible to participate.

RESULTS: Asthma severity classification was based on recall of symptom frequency, nighttime symptoms, and exacerbation frequency before a diagnosis of asthma was made
or at a time when the patient’s asthma was not controlled. Similar numbers of adult respondents were enrolled from each severity group: mild (n=435), moderate (n=435), and severe persistent (n=441). Fewer caregivers were selected to take the survey (n=491), identifying 200, 192, and 99 children as having mild, moderate, or severe persistent asthma, respectively. Substantial proportions of adult patients (23%-35%) and pediatric patients (21%-29%) within each severity group of asthma were reported to experience month-to-month or seasonal increases in panting caused by exercise, cough, wheezing, tightness of chest, or shortness of breath during the previous year. General symptom variability (ie, increases interspersed with decreases) during the previous year was reported in 15% to 23% of pediatric patients by child caregivers and by 17% to 25% of adult patients. Decreased symptoms were reported in 18% to 20% of pediatric patients by caregivers and by 9% to 16% of adult patients during the previous year.

CONCLUSIONS: Although symptoms were more likely to decrease in the pediatric than the adult population, both groups reported similar variability of symptoms over time. The variability was consistent regardless of disease severity. It is apparent that for proper disease management, periodic reassessment of asthma therapy is necessary to address changes in symptom severity for both pediatric and adult patients with asthma.

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