Difference in the Perceptions of Asthma Control Between Children With Asthma and Their Parents

To determine the difference in the perception of asthma control between children and their parents in the primary care setting using the Childhood Asthma Control Test (C-ACT).Ninety children in the Netherlands aged 6 to 12 years with an average age of 9.6 years from December 2018 to September 2023 as a part of the Rotterdam Asthma Trial who were cared for by general practitioners with a physician diagnosis of asthma or without a diagnosis of asthma but with 2 or more short-acting beta-agonist (SABA) prescriptions or at least 1 prescription for inhaled corticosteroid (ICS) in the last year. Children who were being treated for asthma in secondary or tertiary care facilities, who had severe comorbidities (except for other atopic conditions), or who were unable to perform spirometry were excluded. The baseline characteristics were predominantly white (87.8%) and male (63.3%).The study used data from a cluster randomized control trial. Data from the C-ACT questionnaires were completed by both the children and their parents at 5 time points (baseline and after 3, 6, 12, and 18 months). The minimum important difference for the C-ACT score is considered as 2 points. The concordance between the C-ACT score percentages given by the children and their parents was determined. A scatter plot was created to determine whether there was a linear relationship between differences at baseline and at 18 months. The study sample was divided into 2 groups—children older and younger than 8 years—to examine how age affects agreement in C-ACT scores.At baseline, the children gave a median C-ACT score of 9/12 and parents gave 14/15. There was a significant difference (P < .001) between children’s and parents’ C-ACT scores at every measurement time, with children’s median C-ACT score being significantly lower throughout the study period. Spearman’s correlation test indicated a moderate to strong correlation from baseline to 18 months.This study showed that parents gave significantly higher scores on the individual items of the C-ACT compared with their children throughout the study period. The agreement between children and their parents was moderate to strong at all follow-up time points. This suggests either that parents underreported symptoms or overestimated their child’s level of control or that children overinterpreted their symptoms. Their results were able to show that it was not the same parents who kept underreporting symptoms compared with their children.Primary care clinicians and asthma specialists often use the C-ACT as a part of their medical decision-making when evaluating the need for treatment changes for asthma over time. This study showed that parents gave significantly higher scores for the C-ACT than their children. It is important for all clinicians to assess both the child’s and caregiver’s perception of their asthma control. The C-ACT should be thought of as a tool to facilitate dialogue on areas to optimize asthma care. It is also important in busy practice to make sure the appropriate stakeholder’s concerns are addressed based on the answers for the C-ACT, making sure they are filled out correctly to assess both the caregiver’s and child’s concerns. Considering the child’s perspective on their symptoms remains vital when deciding on changes to their asthma treatment.