Differences Between Child and Parent Reports of Symptoms Among Latino Children With Asthma
Authors: Lara Marielena , Duan Naihua , Sherbourne Cathy , Lewis Mary Ann , Landon Chris , Halfon Neal , Brook Robert H. 
Published: August 2004

Objectives.
To determine, in a population of predominantly Latino children with asthma 6 to 18 years old, whether parent and child reports of asthma symptoms with exercise differ and to evaluate the validity of child and parent reports of symptoms.

Design.
Data obtained from child and parent interviews; pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow25–75, peak expiratory flow), and observation of symptoms after exercise.

Setting.
Three summer camps for minority children with asthma in Los Angeles County.

Participants.
A total of 97 children with asthma (78% Latino, 12% non-Latino White, 9% Other; 6 to 18 years of age) and their parents.

Intervention(s).
None.

Primary Outcome Measures.
Child and parent reports of cough and wheezing with exercise and pulmonary function tests before and after exercise. While at camp, children underwent spirometry after completing the self-administered survey. The pulmonary function tests were conducted and interpreted according to the pediatric specifications for spirometry, and results &gt;80% of predicted, adjusted for gender, age, height, and race, were considered normal. Six peak expiratory flow rates (PEFR) by peak flow meter also were recorded by trained research assistants immediately before spirometry, and values &gt;80% of predicted based on height were considered normal. To observe child symptoms with exercise, children participated in a relay running race of 200 feet followed by a swimming race of 300 feet. Research assistants measured heart rate and 6 PEFRs using ASSESS portable peak flow meters immediately before and after each exercise. A positive exercise challenge was defined as a 15% reduction in mean PEFR and/or observed asthma symptoms (cough, wheezing, chest pain, asthma attack).

Results.
Of the children, 18% reported never having a cough when they exercised, 46% reported having it occasionally when they exercised, and 36% reported having it quite often or always when they exercised. For wheezing, 20% of children reported never having wheezing when they exercised, 35% having it occasionally when they exercised, and 45% having it quite often or always when they exercised. Parents reported fewer symptoms than did their children. Of the parents, 34% reported that their children did not have cough with exercise, 37% reported few to some days, and 29% reported most days or every day. Forty-seven percent of parents reported that their child did not wheeze with exercise in the last 2 months, 35% reported wheezing on a few days to some days, and 17% reported wheezing most days to every day.
Parent and child reports of cough or wheezing after exercise correlated mildly with each other (parent/child cough r = 0.23; κ = 0.03; parent/child wheezing r = 0.21; κ = 0.14). Children were more likely to report cough: 59 of 71 (83%) of children versus 44 of 71 (62%) of parents. The 22 children who reported cough when their parents did not account for most of the disagreement between parents and children. Children were more likely than were their parents to report wheezing; 55 of 69 (80%) children versus 36 of 69 (52%) parents reported that the child wheezed. The 24 children who reported wheezing when their parents did not account for most of the disagreement between parents and children.
Forty-seven percent of the children had a value &lt;80% of predicted for at least one of the four spirometry tests; 29% of mean baseline PEFRs were &lt;80% of predicted. Overall, 86% of the children met one or more of the following: any percent of predicted pulmonary function tests &lt;80% or any symptom or PEFR reduction of 15% after exercise, or other occurrence of nonexercise symptoms during camp.
Almost all child reports of cough and wheezing correlated significantly with the criterion validity criteria. For example, child reports of wheezing were, as expected, correlated negatively with the percent of predicted FEV1 (r = −0.28) and correlated positively with observed symptoms after exercise (r = 0.3). On the other hand, neither parent reports of cough nor those of wheezing correlated significantly with any of the pulmonary function tests or symptomatic validity criteria.
Parent reports of wheezing were correlated positively with construct validity variables such as 1) parent reports of child's bother (r = 0.35) and activity limitation (r = 0.23) because of asthma; 2) more use of rescue or bronchodilator medications (r = 0.18); 3) more parent worry about asthma overall (r = 0.29); and 4) parent perception of asthma severity being moderate to very severe instead of mild or very mild (r = 0.28). Child reports of cough and wheezing were not correlated significantly with almost all of the parent-reported factors hypothesized to be associated with asthma morbidity.

Conclusions.
Clinicians and researchers evaluating asthma morbidity in children should elicit child reports of symptoms. More research is necessary to understand discordance between child and parent reports of symptoms and its relationship to asthma morbidity experienced by the child.