The ability to perceive accurately the onset and intensity of asthma symptoms is a cornerstone of effective asthma management. Research in pediatric and adult asthma patients has shown the important role of symptom perception in asthma management, morbidity, and mortality. Assessment of symptom perception ability has largely remained an empiric methodology rather than an applied clinical tool. The Asthma Risk Grid represents a clinical application of symptom perception measurement, and pediatric cases are described as clinical examples. Clinical and research applications of the Asthma Risk Grid are presented.

Objective To assess child adherence to preventive asthma medications; to investigate relations between knowledge, reasoning about asthma, and responsibility for management and adherence; and to determine the association between adherence and morbidity. Methods Participants were 106 children with asthma and their parents. Medication adherence was electronically monitored for 1 month. Participants completed self-report measures. Children were interviewed to assess reasoning about asthma. Results Children's adherence was approximately 48% of prescribed doses. Adherence was negatively related to age (r = -.21, p < .05); minority status, F(1, 98) = 7.55, p < .01; and morbidity (r = -.26, p < .01). Age was associated with increased child knowledge (r = .47, p < .001), reasoning about asthma (tau = .23, p < .01), and responsibility for asthma management (r = .44, p < .01). These variables were not associated with adherence. Conclusions Although older children know more about asthma and assume more responsibility for disease management, their adherence is lower than that of younger children. No association was found between adherence and child knowledge, reasoning about asthma, or responsibility for asthma management.

This paper reports the differences between two methodologies for threshold detection or added resistive loads in children and adolescents. The first-generation apparatus utilized a series of laminar flow screens to present various total resistances, while in the second generation the apparatus utilized a servo-controlled cone that occluded an aperture to varying degrees. Protocol modifications in the second generation methodology included forced choice, attentional enhancements, and larger increments of added resistance. Two studies conducted 2 years apart provided data on the First and second generation,, of methodology. All participants in Study 1 (N = 33) and Study 2 (N = 33) were children with asthma. Subjects were matched for both age and asthma severity. Results showed the methodologic improvement, in the second generation to be significant, Tracking and random thresholds were achieved by 85% and 82% of the subjects in Study 2 compared to 76% and 42% in Study 1, respectively. The correlation between the mean tracking and random thresholds was .40 in Study 2 compared to a statistically insignificant result in Study 1, indicating improved reliability. Raw thresholds were correlated with intrinsic resistance in both studies (r =.29-.88). supporting the use of Weber's Law in resistive loading studies of children. Results using the second generation methodologic improvements demonstrate that children as young as age 7 can complete resistance loading protocols, Standard methodology will enhance the comparability between studies.

Objective: The present study implements an experimental paradigm to examine airway reactivity to stress in children with asthma and controls. Method: 114 children with asthma and 30 controls (ages 9–15) participated. The protocol involved 5 min of baseline physiological measurements followed by a 5-min stressful task. Skin conductance (EDG), skin temperature, and heart rate were measured continuously. Airway resistance was measured at baseline and after the task. Results: 110 children (76% of the sample) were significantly “stressed” as shown by physiological changes. Asthmatics and controls differed on overall airway resistance, F(1,108)=12.3, P<.001. The entire sample demonstrated a trend toward increased airway resistance in response to stress, F(1,108)=3.1, P<.08. A portion of asthmatics (22%) had increases of greater than 20% of baseline airway resistance. Changes in airway resistance in response to stress were unrelated to asthma severity, F(2,78)=2.0, ns. Conclusion: Children with asthma and controls demonstrate variation in airway function in response to stress, although increases are likely more meaningful for children with asthma. Further research is needed to examine the mechanisms underlying this response.

Threshold detection of added resistive loads was studied in asthmatic children and compared to data previously obtained in a group of healthy children. The relationships between possible psychological predictors of perceptual ability, the perceptual threshold, and functional morbidity variables were also investigated. Our subjects were 103 children (mean age, 10.9 years) with asthma who completed two laboratory protocols in which they were asked to distinguish breaths with varying degrees of added resistance from unloaded breaths. Using two different computer-driven protocols, resistances were presented as percentages of each child's intrinsic respiratory system resistance (R(rs)). Cognitive ability was assessed through subtests of the Wechsler Intelligence Scale for Children, 3rd edition (WISC-III), and functional morbidity was quantified through a combination of school absences, emergency medical visits, and days hospitalized. Detection thresholds for both protocols were highly correlated with intrinsic resistance (r = 0.49 and 0.66; P < 0.001). Weber fraction thresholds were significantly lower for asthmatic children than healthy controls. Thresholds were not significantly related to either intelligence or pulmonary functional abnormalities due to asthma. Methodologic limitations require cautious interpretation of the results, but we conclude that psychophysical approaches may be useful in the study of symptom perception in pediatric asthma.

OBJECTIVE To determine whether physiological severity of asthma is associated with increased psychological symptoms in children. METHOD Participants were 337 children, aged 7 to 19 years (mean 11.9, SE 0.13), and a parent of each child. Children's asthma severity was rated by experienced pediatric asthma specialists using current guidelines from the National Heart, Lung, and Blood Institute. Children filled out the Children's Manifest Anxiety Scale and the Weinberger Adjustment Inventory. Parents reported on their child's medical history, completed the Child Behavior Checklist (CBCL) about their child, and completed the Pennebaker Inventory of Linguid Languidness as a measure of their own physical symptoms. RESULTS Child-rated anxiety symptoms were unrelated to asthma severity or to markers of asthma functional morbidity. Parental ratings of internalizing symptoms in their children were related to severity. Parent physical symptoms explained 10.2% of the variance in CBCL Internalizing symptoms, and asthma severity added an additional 6.7% to the variance. CONCLUSIONS Asthma severity may be a more salient stressor to parents, who in turn report higher levels of child internalizing symptoms for children with severe asthma, than to children themselves. Contrary to prior hypotheses, children with severe asthma did not rate themselves as having higher levels of anxiety than those with mild or moderate asthma or than standardized norms.

OBJECTIVE:Perception of changes in respiratory symptoms is a critical element in the self-management of pediatric asthma. The purpose of this study was to quantify perceptual accuracy in childhood asthma, to investigate links between symptom perception and functional morbidity, and to examine relationships between psychological variables and perceptual accuracy.METHOD:Eighty-six children, aged 8 to 15 years, attending an asthma camp made subjective estimates of asthma severity immediately prior to spirometry an average of 31 times at camp. The correlation coefficient between these measures (the child's accuracy index) was analyzed in relation to morbidity data and to scores on instruments that assessed trait anxiety, repressive coping style, intelligence, behavior problems, and parental symptom-reporting patterns.RESULTS:A wide range of perceptual ability was found, as children's subjective-objective r ranged from-.39 to .88. Greater perceptual accuracy was significantly related to fewer days missed from school and fewer emergency medical visits. Of the psychological variables assessed, only intelligence was significantly related to accuracy.CONCLUSIONS:Symptom perceptual ability is an important psychosomatic factor affecting the course of asthma for some children. Further study is indicated to understand psychological variables in addition to intelligence that may determine a child's perceptual accuracy.

The objective of this study was to determine patterns of pulmonary function abnormalities and to evaluate how adequately peak flow monitoring was correlated to other spirometric indices in childhood asthma. Ninety-one children, aged 8-15 years, with moderate-to-severe asthma were repeatedly tested in a summer camp. On-site medical staff permitted 24-hour-a-day supervision. Subjective and objective clinical evaluations of asthma status were made over 14 consecutive days. Detailed clinical history and clinical observations were made by an experienced staff, and a total of 2,663 pulmonary function tests were performed regularly three times daily and whenever a child sensed asthma symptoms. Patterns of obstruction were divided into large airway abnormalities and small airway abnormalities. There was a low concordance between standard large airway measures, such as the peak expiratory flow rate (PEFR) or the forced expiratory volume in 1 second (the FEV(1)), and measures of small airway obstruction, such as the forced expiratory flow rate 25-75% (FEF(25-75)). Normal PEFR measurements do not always indicate that all other pulmonary function measures are normal. In fact, 18% of children with a normal PEFR had abnormal FEF(25-75) values. Results demonstrated that the FEF(25-75) was the most specific and sensitive measure of airway obstruction. PEFR is widely used to monitor asthma symptoms objectively because it is technically simple to perform, relatively inexpensive, and helpful in most cases. It is, therefore, appropriate for asthma education programs to recommend PEFR as an objective measure to guide in making therapeutic decisions. Our data and clinical observations support the ''Guidelines for the Diagnosis and Management of Asthma'' of the NIH Health Asthma Education Program that suggest that children have more complete pulmonary function testing along with frequent PEFR measures. Many children may appear asymptomatic, while recording normal PEFR measures, and still having significant asthma. Repeated pulmonary function testing and evaluation of the pattern of respiratory obstruction aids in managing this challenging group. We recommend that efforts be made to develop a simple and inexpensive method of measuring FEF(25-75) that will allow this measurement to be made even at home. (C) 1995 Wiley-Liss, Inc.

Allergic reactions to latex, varying from urticaria to life-threatening IgE-mediated anaphylaxis, have been described in patients with spina bifida. In a study of 50 patients 60% had a latex allergy identified by history, a radioallergosorbent test and/or a skin prick test. Latex allergic patients had undergone statistically more surgical procedures than nonallergic patients (9.5 versus 6.7) with a p value of 0.03. The presence of latex allergy did not correlate with the number of intra-abdominal procedures (1.9 versus 1.4) or with the number of years on clean intermittent catheterization (7.7 versus 5.9). These results suggest that latex allergy is acquired through multiple exposures due to breakdown of blood tissue barriers. Therefore, we recommend that all patients with spina bifida undergoing surgery be evaluated for latex allergy and that all surgical procedures in spina bifida patients, from the time of birth, be performed in a latex-free environment.

Children with chronic illness need to adapt to more stresses than do healthy children. Research highlights the problems of children with chronic illnesses but not how they cope in response to the stress created by these problems. Cognitive appraisal of a stressor and of response options is an important aspect of coping. Our cross-sectional study investigated whether children with chronic illness used cognitive strategies for coping as often as did healthy children. One hundred seventy five children from summer camps with juvenile arthritis, asthma, or diabetes were compared with 145 healthy school children. Spontaneous responses to common painful and stressful events were categorized into coping or catastrophizing ideation. Data on anxiety, disease severity, and other sociodemographic variables were obtained. Coping strategies were reported by 64% of children with chronic illness and 63% of healthy children and varied significantly with age (p < .05) in both groups. Children with different chronic illnesses performed similarly except for a trend among children with severe juvenile rheumatoid arthritis who had higher rates of coping. For the individual stressful events, the rate of coping varied from 46% to 86%. The highest rates of coping responses were found with the child's recent personal stressful event where adolescents with chronic illness were twice as likely to offer more complex coping responses. More children with chronic illness than healthy children offered coping strategies in response to venipuncture (p < .001) but not to dental injection. Children with chronic illness report coping as their predominant strategy for adapting to common painful and stressful events. We need to recognize the role of cognitive strategies and how their use varies as a function of the different stresses faced by children with chronic illness.J Dev Behav Pediatr 14:217–223, 1993. Index terms:chronic illness, coping, arthritis, asthma, diabetes.