PURPOSE: Children with asthma may have a variable level of symptom burden and asthma control. We characterized the variation in disease burden over 12 months using NAEPP severity classifications.
METHODS: Children were identified via healthcare claims data or physician visits and subsequently monitored monthly by telephone surveys. Asthmatics with two or fewer controller dispensings in prior six months were included to focus on children with milder asthma at baseline. This survey included 381 children aged 6-17 years with at least one parent-completed questionnaire per season. Outcome measures were asthma symptoms, health outcomes, healthcare utilization, and medication use.
RESULTS: Overall, 54% of the children were classified with mild intermittent disease at baseline and three-quarters of their person-months continued in this classification during the following year. However, the majority (70%) of children met criteria for persistent asthma [mild (45%), moderate (35%) or severe (38%)] during at least one follow-up month. Only 30% of children with mild intermittent disease at baseline remained at this severity level consistently over the following year. Children with persistent disease at baseline also exhibited significant symptom variability with more than three-quarters experiencing a higher level of burden of disease compared with baseline over the subsequent year. The majority of subjects with persistent asthma at baseline experienced more than three different categories of symptom burden across the following year with half of their person months classified as mild intermittent disease.
CONCLUSION: Symptom burden was highly variable for children with intermittent and persistent asthma. Only a minority of children continued to experience mild intermittent symptoms consistently during all 12 months of the study, while the majority experienced a higher level of disease burden.
CLINICAL IMPLICATIONS: Reliance on a single point-in-time assessment could lead to misclassification and under-treatment of underlying disease in children with asthma. Regular assessment of asthma symptoms and control as recommended by asthma guidelines may reduce asthma morbidity.
DISCLOSURE: Theresa Guilbert, Employee GlaxoSmithKline.