Abstract
ObjectiveFew studies have examined variability among physicians in the perception and interpretation of asthma symptoms. We report the results of a pilot study to investigate the variability of symptom description and diagnostic labeling and nomenclature among a group of clinicians using standardized audiovisual presentations of asthma.MethodsPracticing pediatricians in Wisconsin recruited from an electronic mailing list were shown the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire online, and asked to describe the symptoms and signs they observed and suggest possible diagnostic labels for each presentation.ResultsA total of 113 pediatricians (mean age = 43 years; 56% female) responded to ≥1 of the 5 video scenes. The number of practitioners who described the principal symptom(s) of asthma depicted in the 5 sequences ranged from 5.5% for Scene 5 (featuring both dyspnea and wheeze), to 100% for Scene 4 (featuring cough). The number who suggested label of ‘asthma’ as a possible cause of the presentations ranged from 69.7% for Scene 3 (featuring nocturnal wheeze), to 92.7% for Scene 2 (featuring exercise induced wheeze).ConclusionThere is important unexplained variation in the perceptions and labeling of asthma symptoms among pediatricians. These differences may influence the likelihood of diagnosis and the apparent prevalence of asthma. Many participants suggested that the ISAAC video be used in the education and training of pediatricians.
Highlights
The lack of a standardized definition of asthma is an ongoing challenge for asthma epidemiology
Unlike Europe, Asia, and Australia, where asthma epidemiology is largely informed by the European Community Respiratory Health Survey (ECRHS) and the International Study of Asthma and Allergy in Childhood (ISAAC), investigation of asthma prevalence and asthma-related morbidity in the United States has been predicated upon national surveys in which the key indicator for asthma is report of physician diagnosis.[1,2,3]
[7] Artefactual changes in asthma prevalence may arise from changes over time in the perception and interpretation of symptoms, [8,9] and differences in the proportion of the population with symptoms labeled as asthma.[10,11,12]
Summary
The lack of a standardized definition of asthma is an ongoing challenge for asthma epidemiology. Systematic differences in the perception of asthma symptoms and their clinical interpretation and labeling may play an important role in the apparent patterns of disease prevalence. [7] Artefactual changes in asthma prevalence may arise from changes over time in the perception and interpretation of symptoms, [8,9] and differences in the proportion of the population with symptoms labeled as asthma.[10,11,12] Early population-based research suggested that asthma epidemiology is dependent on the diagnostic habits of physicians in the locale, as well as a measure of the prevalence of a specific syndrome. In order to adequately interpret data collected from these national surveillance efforts, a valid methodology for reliably determining how physicians perceive and label asthma and asthma symptoms across geographic and clinical settings is required
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