Parents who have higher expectations for their child’s functioning with asthma have children who are less likely to have asthma symptoms, according to a new study from researchers at HMS and Boston University. Furthermore, if parents have accurate perceptions of how well symptoms can be controlled, their children are more likely to use controller medications appropriately. The research, which appears in the October Pediatrics, also found that parental perceptions varied across racial and ethnic groups and may influence disparities in child asthma care.
“Our findings suggest that parents’ expectations and perceptions are key factors influencing how well their children’s asthma is controlled and how effectively they use medications,” said senior author Tracy Lieu, HMS professor of ambulatory care and prevention at Harvard Pilgrim Health Care and HMS.
The investigators conducted telephone interviews with more than 700 parents of children aged 2 to 12 years with persistent asthma who were patients of Neighborhood Health Plan and Harvard Vanguard Medical Associates in Boston. The parents were asked how severe their child’s actual asthma symptoms were, how well they believe their child’s symptoms could be controlled, and how asthma would or would not limit their child’s activities and health. In addition, parents were asked about other competing family priorities such as financial and job concerns, neighborhood safety, family relationships, and their own health.
Children were more likely to have troublesome symptoms if their parents had low expectations for how well their asthma could be controlled. They were also more likely to have poorly controlled symptoms if there was no set time or routine for taking asthma medication.
The study found that suboptimal asthma control was more common in Hispanic children (51 percent) than in children who are African-American (37 percent) or Caucasian (32 percent). Controller medication underuse was more prevalent in Hispanic (44 percent) and black (34 percent) children than in those who are white (22 percent).
Concerns about other family issues and lack of parental knowledge about asthma were also related to worse asthma control. Some parents mistakenly thought asthma is an intermittent rather than chronic condition, that two days of symptoms per week was adequate control, and that medication use was not necessary or necessary only when their child had symptoms. (Daily medication use is recommended for children with persistent asthma.)
Asthma is one of the most common childhood chronic illnesses and the most frequent cause of children’s hospitalization. Children from racial and ethnic minorities and families of low socioeconomic status are at increased risk of having poorly controlled disease. In light of the study findings, the investigators believe it is important that clinicians identify and work with parents who have low expectations about asthma control and educate them about treatments that can improve their child’s condition.
“Raising parents’ expectations for how well their children can be doing with asthma may be one of the keys to reducing racial and ethnic disparities in asthma outcomes,” Lieu observed.
Conflicts of interest: The authors declare no conflicts of interest.
Funding Sources: The National Institute of Child Health and Human Development and the Department of Veterans Affairs, Health Services Research and Development Service (Bokhour).
