ARE THE CHILD'S RESPIRATORY SYMPTOMS CONTROLLED?
Similar to asthma severity, asthma control is defined in terms of reducing impairment and risk (Figure 4).6 In contrast to severity, asthma control reflects the degree to which asthma risks, symptoms, and limitations are minimized and goals of therapy are met. Asthma control becomes the emphasis for clinical management once therapy is initiated. Decisions to maintain or adjust therapy are based on the child's level of asthma control.
The guidelines recommend periodic assessment and monitoring of asthma control at 1- to 6-month intervals. 6 The frequency of HCP visits depends on the patient's level of asthma control and is based mainly on clinical judgment. As previously discussed, for children receiving a therapeutic trial of asthma medication, control should be assessed within 4 to 6 weeks of therapy initiation. Generally, children with intermittent or mild persistent asthma that has been controlled for 3 months or more should see their HCP every 6 months. Children with uncontrolled asthma, severe persistent asthma, or difficulty in following a treatment plan should see a physician more frequently. If step-down therapy is anticipated, the guidelines recommend a 3-month follow-up interval. The primary methods of monitoring asthma control in children are self-assessments filled out by a parent or family member and evaluation by the HCP.
The use of self-assessment tools, such as patient diaries or standardized questionnaires, is encouraged to obtain the family's perspective on the child's asthma control.6 However, currently available asthma control tools were not specifically designed for very young children. Instruments to assess asthma control have been developed for children aged 4 to 11 years,35 children and adolescents aged 5 to 1736 or 1 to 18 years,37 and adults.38-41 All of these tools were developed before the guidelines recommended the use of the risk domain for assessment of asthma control. In addition, no tool was specifically designed and validated for use by caregivers of children younger than 5 years who have respiratory symptoms consistent with asthma symptoms. For school-aged children, parents' and children's perceptions of asthma symptoms or severity can differ. 42,43 Nonetheless, a caregiver proxy for symptom assessment is necessary in younger children who are not able to complete a questionnaire.