Outcomes in Pediatric Asthma
Assessment of health status and quality of life outcomes for children with asthma,☆☆

https://doi.org/10.1067/mai.2001.114949Get rights and content

Abstract

Increasing interest has been directed to understanding health outcomes associated with pediatric disease processes, including asthma. Salient areas of interest to health outcomes research include the child’s and parent’s subjective experience with the disease, a concept most often identified as quality of life. Quality of life reports fit within a broader scope of outcome measures embodied in the concept of children’s health status. This article provides a description for how a child’s health status can be understood theoretically, from a research perspective and in clinical practice. Emphasis is directed to how information obtained from both the child and parent is critical to outcomes research and clinical practice. Unique methodologic problems in assessing child health outcomes such as the challenge of understanding how the child’s changing cognitive development may have an impact on responses to outcome measures and the role of contextual variables such as family characteristics are discussed. A variety of subjective and objective outcome measures currently exist that may be used in research on children with asthma. Practical guidelines for implementing outcomes research for children with asthma are presented. Clinical researchers must use multiple outcome measures for assessing asthma characteristics, including psychosocial characteristics, which have an impact on adherence and treatment regimens. (J Allergy Clin Immunol 2001;107: S473-81.)

Section snippets

Health status outcomes: A conceptual model

To assess quality of life outcomes, it is necessary to place the research concerns within a model of understanding health outcomes. The pediatric health status outcomes model3 provides a comprehensive model that can assess the consequences of chronic childhood illnesses and be adapted to the study of pediatric asthma. Although quality of life outcomes were not specifically addressed within this framework, this model has been adapted to include quality of life measurement (Fig 1).

. Pediatric

Methodologic concerns with younger children

Unique methodologic problems in assessing health outcomes occur when the child’s experiences with illness are a focus of study. The child’s changing cognitive development is thought to have an impact on his or her responses to quality of life measures. Rapid changes in cognitive development are most dramatic from birth to school age, making this a challenging time for directly assessing the child’s experiences with asthma and perceptions of quality of life. In studying populations of

Specific methods

The 2 most common methods currently used in health status outcomes research are the “absolute health status” and “change in health status” outcomes procedures. When absolute health status is measured, a variety of outcome measures are used. Given the conceptualization of health status outcomes previously described, research procedures typically use a battery of outcome questionnaires assessing the domains of influence proposed to interact with disease characteristics, including symptom control.

Measurement strategies with children and their parents

A variety of subjective and objective measures currently exists that may be used in research on children with asthma. Critical for each of these measures is (1) their ability to provide critical information about variables that may mediate the control of asthma symptoms and (2) how the measure can explain differences in health outcomes, an issue that has not been widely addressed in the research literature. Each of the measures described, however, offers a unique perspective for outcomes

Measurement strategies for family and cultural context

Contextual variables such as family characteristics and cultural beliefs and values are believed to play a central role in health status outcomes including treatment compliance. Although a comprehensive review of measurement strategies for assessing these variables is not possible within the scope of this article, several of these measures are presented to guide researchers. Critical to all of these measures are their known psychomet-ric characteristics and particularly their reliability

Recommendations

A variety of recommendations addressing methodologic problems confronting researchers in pediatric asthma in younger children can be drawn from clinical experience and the preceding information. Although not meant to be exhaustive, these points must be considered when outcome studies are being developed.

  • 1.

    For younger children with asthma, limited outcome measures are available to directly assess the child’s perceptions of illness, including quality of life. It is valuable to ascertain the

Conclusions

An awareness of psychosocial variables mediating asthma awareness and control is vital for clinical care and research investigations of pediatric asthma. Contributions to understanding health outcomes for pediatric patients with asthma will require that both subjective and objective measures be obtained from the parent and child. Quality of life measures provide information on the child and parent’s subjective experience with asthma, which can be very useful in developing or changing a clinical

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    Dr. Annett has no significant financial relationship or interest in Merck & Co. He has prepared this report to present factual, unbiased information and attests that no commercial association has influenced this report, nor does this publication constitute a commercial or personal conflict of interest.

    ☆☆

    Reprint requests: Robert D. Annett, PhD, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-5311.

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