Altered Symptom Perception in Children With Asthma Is Associated With Poor Childhood Opportunity and Adverse Outcomes

To determine how altered asthma symptom perception in children relates to development of uncontrolled asthma features, health inequity, and longitudinal asthma outcomes.School-aged children in Atlanta (n = 371) with asthma (≥12% forced expiratory volume in 1 second postbronchodilator response) without history of premature birth (<35 weeks) or another chronic airway disorder.Participants completed the 6-item Asthma Control Questionnaire and were assessed for features of asthma control (cough, chest tightness, wheeze, and difficulty breathing), atopic sensitization (by specific IgE or skin testing), and lung function. Chart review was used to assess medical utilization for up to 12 months. Asthma was categorized as controlled (≤2 days per week with symptoms), uncontrolled (>2 days per week with symptoms), or with altered symptom perception (discrepancy between 6-item Asthma Control Questionnaire and provider classification). Further stratification was performed with the Childhood Opportunity Index, which estimated neighborhood opportunity using indicators related to education, health, environment, and socioeconomic resources. Analyses were adjusted for age, sex, race, and obesity.Of the 371 children, 230 were controlled (62%), 87 were uncontrolled (23.5%), and 54 had altered symptom perception (14.6%). Children with altered symptom perception were clinically similar to children with uncontrolled asthma, but had more severe exacerbations, required greater health care utilization, were prescribed more controller medications, and ultimately had poorer lung function compared with children with controlled asthma. In contrast to both controlled and uncontrolled children, those with altered symptom perception were more likely to live in zip codes with a higher percentage of Black children, higher unemployment, and higher percentage of families living in poverty. They also had less childhood opportunity (lower Childhood Opportunity Index scores), suggesting poorer access to educational, social, and health resources, lower food accessibility, and more toxic exposures.In populations with social vulnerability and poor asthma outcomes, culturally sensitive feedback from providers to improve symptom perception during routine clinical encounters may promote health equity and help identify barriers leading to health disparities. Additional studies to better understand the effectiveness of such interventions are needed.These findings suggest that external factors predisposing to poor health literacy and limited access to resources in asthmatic children (and their families) play a significant role in disease control and progression, leading to worse health outcomes. This illustrates the need for a multifactorial approach, emphasizing education during clinician visits early after diagnosis in this population.