Serious morbidity of asthma seems to be on the increase over past few decades.  Class and race disparities for asthma prevalence are becoming more evident (with prevalence highest among children from African American, Puerto Rican, and low-income families).  The data source for many of these prevalence reports is a question posed by the National Health Interview Survey: “Has a doctor or other health professional ever said your child has asthma?” How accurate are the answers to this question?  Is this question open to culturally-specific interpretation of symptoms or of a diagnostic label (such as “asthma) and is this shaping the accuracy of their responses? 

This study analyzed data from the Medical Expenditure Panel Survey, which is an ongoing study that uses a complex sampling process across the USA.  Over 10,000 children (ages 0-17years) were included in this analysis, whereby parents list the diagnosis they were given.  These data was then corroborated with pharmacy records.  Pharmacy records allowed researchers to determine what, if any, asthma medication was prescribed and filled.  

Asthma was reported by 3.8% of parents.  Asthma medications were purchased for 2.5% of the children.  Although these groups overlapped significantly, there was also a significant degree of non-overlap.  More specifically, 45% of parents with a child receiving asthma medications do not report asthma.  Likewise, many reporting a diagnosis of asthma are not put onto asthma medications.  Reporting “asthma” did not differ among ethnic and racial groups, but there were disparities among those with and without insurance coverage for correct identification of this diagnosis.  The authors conclude that surveys of parental reports of asthma over-look many patients who have active disease.  Dependence on parental reports may underestimate asthma prevalence. 

(Roberts E.  Arch Pediatr Adolesc Med 2003; 157:449-455.)

Comment:  In schools, asking parents for the diagnosis is often how nurses know a student has asthma.  If parents would reliably divulge information about all prescribed medications their children receive, even those not administered during the school day, nurses would be able to identify more children with asthma.  –H.T.