Morbidity associated with childhood asthma continues to climb, and a recent study suggests one factor may be that health care providers and parents of children with asthma have different beliefs about the condition and its treatment.

Researchers interviewed 228 parents of children with asthma to assess their understanding of asthma, compare that understanding with professionals' beliefs and recommendations, and determine how they might affect the children's treatment.

The parents' knowledge about asthma pathophysiology, pharmacology, and triggers was essentially accurate, but there were significant discrepancies between parents' and professionals' beliefs in other areas. Parents viewed asthma as episodic, acute, and having uncontrollable symptoms, whereas professionals consider it a chronic condition, present even when symptoms are not in evidence. The National Asthma Education and Prevention Program (NAEPP) Expert Panel 2 guidelines stress treating even mild symptoms, but parents focused on treating acute episodes and severe symptoms. Parents also have a more negative view of the use of antiinflammatory medications and, consequently, often medicate their child inadequately.

Twenty-seven percent of parents believed asthma medications should be used only as a last resort, and 33% thought children should be taken off them as soon as possible. Although parents and professionals had similar beliefs about when to contact the provider, 39% of parents said they wouldn't contact the provider even when night symptoms occurred more than twice monthly and 37% wouldn't do so even if rescue medication was needed more than twice weekly. The NAEPP guidelines call for a change in the medical regimen in both of these circumstances. The authors emphasize that for asthma care to improve, practitioners need to assess and acknowledge parents' beliefs and encourage their participation in decision making.

Linda Epstein, RN