Variability in the Labeling of Asthma Among Pediatricians

Practicing pediatricians use various terms to describe standardized symptoms of asthma.

Asthma, the most common chronic disease that pediatricians diagnose, also is underdiagnosed—particularly in communities where residents have low-socioeconomic status and poor access to health care—masking the true prevalence of the disease.

These investigators examined the variability in labeling of asthma using the International Study of Asthma and Allergy in Childhood (ISAAC) video questionnaire. This standardized audiovisual presentation of asthma presents five short (25 second) sequences of young adults of various ethnicities exhibiting various asthma symptoms:

  • Wheeze at rest (this primary symptom was identified and asthma suggested by 86.7% of respondents)
  • Wheeze with exercise (identified by 86.4% of respondents)
  • Nocturnal wheeze (identified by 64.2% of respondents)
  • Nocturnal cough (identified by 75.2% of respondents)
  • Shortness of breath and wheeze (identified by 4.6% of respondents)

Some 116 clinicians in Wisconsin completed the questionnaire. In all, 70 diagnostic labels were used for the five scenes with asthma the diagnostic label 49 percent of the time for all five scenes. Most respondents (64.5%) correctly reported the principal characteristic for three of the five scenes; fewer (3.5%) for all five.

Many participants, as well as the authors, suggest that the ISAAC video be used to educate and train pediatricians.

“There is an opportunity to simultaneously improve the quality of asthma management and refine epidemiological measurements and public health surveillance of asthma by matching and co-evolving these types of audiovisual instruments with physician expectations and practices,” the authors write.

Read what RWJF Health & Society Scholars alumni David Van Sickle and Sheryl Magzamen have to say about the variances in physicians’ perceptions and diagnoses of asthma. Read the story

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