Parent-child agreement in reporting of current wheeze: can we trust questionnaires?

Abstract

Parental and children’s questionnaires are used to assess respiratory symptoms, but we know little about their validity against objective markers of asthma. We studied agreement between parent and child reported current wheeze in Swiss schoolchildren and its association with FeNO and FEV1. We analysed data from Luftibus in the school, a population-based survey of respiratory health in children done in the canton of Zurich. Parents completed a questionnaire at home, children at school. We analysed parent-child agreement on wheeze with Cohen’s kappa and the association of parent and child reported wheeze with FEV1% predicted (adjusting for age, sex) and FeNO (adjusting also for hay fever) with linear regressions. We received questionnaires from 3113 families (median age 12years, range 6-17). Prevalence of wheeze was similar when analysing children’s (9%) and parents’ (8%) questionnaires, but agreement was poor (kappa 0.37, 0.31-0.43). Wheeze was reported by the parent only in 128 families (4%), child only in 166 (6%) and both in 108 (4%). Children had higher median FeNO and lower mean FEV1% if both reported wheeze (FeNO 31.2; FEV1% 91.3) than parent only (FeNO 17.8; FEV1% 92.4), child only (FeNO 15.5; FEV1% 94.4) or none (FeNO 11.4; FEV1% 94.1). Wheeze was similarly associated with FeNO and FEV1% when using parents’ (FeNO 14.7, 95%CI 11.4-17.9; FEV1% -2.1, 95%CI -3.7 to -0.4) vs children’s answers (FeNO 12.5, 95%CI 9.6-15.4; FEV1% -0.7, 95%CI -2.2 to 0.9). Parent-child agreement on reported wheeze is poor, but both reports are similarly associated with objective markers of asthma. If parents and children both report wheeze, the probability that this reflects true asthma seems high. Method: Lunge Zurich