By Dr. Larry Chiaramonte
We recently came across a story with the headline:
“Parents underestimate kids’ asthma symptoms”
“NEW YORK (Reuters Health) – Parents of kids with asthma don’t always realize when
their children’s treatment is inadequate, a new drugmaker-funded survey suggests. While more than seven out of every 10 parents interviewed described their child’s asthma as “mild” or “intermittent,” the disease was adequately treated in only six in 10 kids.
“Based on stricter guidelines, the number of kids whose symptoms were kept in check by drugs dropped to fewer than two in 10, according to the new results, published in the European Respiratory Journal.…
“For the survey, researchers interviewed 1,284 families in Canada, Greece, Hungary, The Netherlands, South Africa, and the UK. They asked the parents about how bad their child’s asthma was, using a common 25-point questionnaire called the Childhood-Asthma Control Test (C-ACT). Then they interviewed the children and compared their answers to those of their parents.
“One in four children whose parents described their asthma as “mild” or “intermittent” had poorly controlled asthma, defined as a score of 19 or lower on the test. Using stricter asthma control guidelines, the number of kids whose disease was poorly controlled increased, report Dr. William Carroll of Derbyshire Children’s Hospital in Derby, UK, and colleagues. The study also found children tended to be better than their parents at determining how well their asthma was being treated.”
Some may be tempted to discount the findings because of this sentence: “The research was funded by Nycomed, a Swiss company that makes asthma medications and also helped write the new report.”
The influence of drug money on scholarship should be of concern to all of us, but I
would say that in this instance it’s pretty innocuous. These observations comport
entirely with what Paul and I have been harping about for years. And in this case
the journalists are “fair and balanced” in the best sense of the phrase. They print
“[O]ne expert said more medication is not the be-all and end-all for children.
“‘The idea of total control…is not where we should be putting our energy,’ Dr. Barbara Yawn from Olmstead Medical Center in Rochester, Minnesota, told Reuters Health in an email.
“’Instead of just giving children with stubborn breathing problems more medication, she said better communication is needed to determine how children’s lives are affected, and what it will take to prevent their symptoms.’”
Bravo, Dr. Yawn. I believe a patient’s or parent’s perception affects their compliance with taking the prescribed medication. We have shown this perception becomes more accurate with daily peak flows done at home.
For the record, I have written that the primary focus of asthma treatment should be control, using strong dosages of inhaled corticosteroids (ICS), and then tapering off as inflammation improves. But I have also placed just as much emphasis on non-medication strategies such as better housekeeping, smoking cessation, and, in the case of my work in the diesel-rich South Bronx, working on altering the larger environment for the well-being of patients. That will be a big part of the new specialty asthma clinic I am helping found in Hunts Point, or as we refer to it at this site, Ft. Asthma.