Assessment of asthma control by children and parents.

Recent guidelines place a strong emphasis on monitoring asthma control and adjusting treatment accordingly [1]. Several tools are available to assess asthma control, including the asthma control test and childhood asthma control test (C-ACT). These tests were developed to detect uncontrolled asthma and are widely used in research and patient care [2, 3]. The C-ACT is a seven-item questionnaire which is designed and validated for children from 4–11 yrs of age and addresses the previous 4 weeks. The C-ACT is divided into two parts. The first is filled in by the child and consists of four questions on perception of asthma control, limitations of activities, coughing and nocturnal awakenings. Response levels vary from 0 to 3. The second part is filled in by a parent or caregiver and consists of three questions on daytime complaints, daytime wheezing and awakenings at night, with response levels between 0 and 5. The C-ACT score is the sum of all scores, ranging from 0 (poorest asthma control) to 27 (optimal asthma control). A cutoff of f19 indicates uncontrolled asthma [4]. Because the C-ACT consists of questions answered by the child and by the parent, this instrument offers the possibility to compare patient's and parents perception on asthma control measured at the same time. Earlier studies have shown that parents tend to under report asthma symptoms of their child and that children may adapt their activity level to their asthma symptoms [5, 6]. We hypothesised that parents would underestimate their children's asthma control, and compared C-ACT subscores of children and parents. We included children aged between 4 and 11 yrs with a doctor's diagnosis of asthma who visited KinderHaven, our outpatient asthma clinic (Rotterdam, the Netherlands), between January and December 2011. All children and parents completed the C-ACT as part of routine patient care. The child completed the first four questions under supervision of the parent, and then one of the parents completed the remaining questions and calculated the total score before visiting the doctor or nurse. For this study formal medical ethical permission was not required according To compare asthma control scores between children and parents, Spearman's correlations and the Intraclass Correlation Coefficient (ICC) were calculated. Scores of the children and the parents were expressed as percentage of the maximum, and pairwise compared using the Wilcoxon Signed Ranks Test. To test the effect of age, mean differences per age category were compared using ANOVA. …