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.