Asthma Module Research Articles

Using the PedsQL™ 3.0 asthma module to obtain scores comparable with those of the PROMIS pediatric asthma impact scale (PAIS)

The National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS) has developed several scales measuring symptoms and function for use by the clinical research community. One advantage of PROMIS is the ability to link other scales to the PROMIS metric. The objectives of this research are to provide evidence of validity for one of the PROMIS measures, the Pediatric Asthma Impact Scale (PAIS), and to link the PedsQL™ Asthma Symptoms Scale with the metric of the PAIS. Descriptive statistics were computed describing the relationships among scores on the PAIS, the PedsQL™ Asthma Symptoms, Treatment, Worry, and Communication Scales, and the DISABKIDS Asthma Impact and Worry Scales for approximately 300 children ages 8-17. A novel linkage method based on item response theory (IRT), calibrated projection, was used to link scores on the PedsQL™ Asthma Symptoms Scale with the metric of the PAIS. The PAIS exhibited strong convergent validity with the PedsQL™ Asthma Symptoms Scale, and less strong relations with the other five scales. The linkage system uses scores on the PedsQL™ Asthma Symptoms Scale to produce relatively precise score estimates on the metric of the PAIS. Results of this study provide evidence for the validity of the PAIS, and a method to use scores on the PedsQL™ Asthma Symptoms Scale to estimate scores on the metric of the PAIS, in partial fulfillment of the PROMIS goal to provide a lingua franca for health-related quality of life.

Using the PedsQL™ 3.0 asthma module to obtain scores comparable with those of the PROMIS pediatric asthma impact scale (PAIS)

Using the PedsQL™ 3.0 asthma module to obtain scores comparable with those of the PROMIS pediatric asthma impact scale (PAIS)

Asthma That Is Not Well-Controlled Is Associated with Increased Healthcare Utilization and Decreased Quality of Life

Background. Relationships of asthma control to other asthma outcomes have been incompletely documented. Objective. This study examined the relationship between asthma control and health-related quality of life (HRQL) and subsequent healthcare resource utilization. Methods. A 1-year online prospective longitudinal survey was conducted in 497 adults and 170 children with asthma treated in the past year. Control was measured by Asthma Control Test™ (ACT) and Childhood ACT™ (C-ACT)™ scores dichotomized into “well-controlled” (scores >19) or “not well-controlled” (scores ≤19), and HRQL was measured using the PedsQL™ 3.0 Asthma Module (children) and the SF-12 Health Survey (adults). Multivariate models were used for analysis. Results. HRQL scores were significantly lower for adults (mean decrease 3.4) and children (mean decrease 12.8) whose asthma was not well-controlled compared to patients with well-controlled asthma. Adults with asthma that was not well-controlled at baseline had a threefold greater risk of an asthma-related doctor visit and a 10-fold greater risk of an emergency department (ED) visit for asthma in the subsequent 9 months (odds ratio (OR) = 3.3 and OR = 11.3, respectively). Children with asthma that was not well-controlled had a nearly fivefold increased risk for subsequent asthma-related doctors' and ED visits (OR = 4.8 and OR = 4.9, respectively). Conclusion. Both adults and children with not well-controlled asthma had significantly lower quality of life and were more likely to require an office or ED visit for asthma compared to patients with higher ACT scores. Therefore, it is important to continually assess asthma control and adjust controller therapy accordingly.

Study of consistency between asthma children's self-assessment health-related quality of life and their proxies' assessment

Objective To examine the consistency between asthma children's self-assessment health-related quality of life and their proxies' assessment, to give theoretic basis of clinical treatment for asthma children. Methods Parents and asthma children completed the PedsQLTM 4.0 Generic Core Scales and PedsQLTM 3.0 Asthma Module during an outpatient visit or in the hospital. Wilcoxon signed rank test and ICC were used to compare the difference between asthma children's self-report and their proxies' report. Results The findings indicated that neither the total scores nor domain scores (except physiological domain) between asthma children's self-reports and proxies' reports (parents most of all)showed inconsistency. The value of ICC was not less than 0.7 except physiological dimension and showed consistency. Some different information in several domains was founded by the scores after layered by age. Conclusions There are consistency between children's self assessment of health-related quality of life and their proxies' assessment based upon results of PedsQLTM scale. Key words: Asthma children; Quality of life; Proxy; Consistency of scale

44 Quality of Life in Greek Children with Asthma

Background: Asthma is a multisymptomatic and multifactorial disease with a various therapeutic approach that can have a substantial effect on quality of life (QoL).Aim: To evaluate the QoL in children with asthma in Greece and to describe the impact of asthma and its treatment on the child's well-being.Methods: The study participated 504 asthmatic children and one of their parents. Qol was assessed with DISABKIDS-Smiley measure for children aged 4-7 years and with DISABKIDS DCGM-37 and Asthma Module for children 8-14 year old, along with special forms for demographic and clinical data.Results: 315 children (122 girls, 193 boys), 4-7 years old (Group A) with mean age 5,35 years and 189 children (8-16 years old) with mean age of 10,22 years (Group B) participated the study. Age of diagnosis, treatment duration, mother's educational level and level of asthma control were found to have positive effect on children's QoL. On the contrary, passive smoking (especially when the mother was a smoker), presence of pets or animals, the level of contact with allergens and asthma severity were found to have a negative effect on quality of life, especially in younger children (4-7 years).Conclusions: Asthma control and severity are in close relation but they express different clinical dimensions of asthma. Major determinant of asthmatic children's QoL is the level of asthma control and affects it independently of any other factor. Moreover, even the presence of mild asthmatic symptoms affects quality of life.

The relationship between intimate partner violence and children’s asthma in 10 US states/territories

Intimate partner violence (IPV) has been shown to negatively impact the health of both the adults who experience IPV and the children who are exposed to IPV. Although IPV experienced by women has been linked to children's asthma, this study is the first to examine this question among both women and men, and the first study in the United States to examine this question as part of a population-based data set. In 2005, ten US states/territories administered an IPV module and a children's asthma module within the Behavioral Risk Factor Surveillance System (BRFSS). Lifetime IPV was assessed by four questions that asked about threatened, attempted, or completed physical violence, as well as unwanted sex, by a current or former intimate partner. The children's asthma module asked respondents to report whether a randomly selected child in their household had ever been diagnosed with asthma and whether the same child currently had asthma. Women who experienced lifetime IPV, in contrast to women who never experienced IPV, were significantly more likely to report that their children had ever had asthma and currently have asthma. Among men, significant differences were not found when comparing men who reported lifetime IPV to those that did not report lifetime IPV. The results highlight the importance of primary prevention of IPV, as reducing the occurrence of IPV could improve not only the long-term health of those who experience IPV but also the health of their children.

A randomized trial to test the effectiveness of art therapy for children with asthma

Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma. To test an art therapy intervention in a randomized controlled trial in children with asthma. Twenty-two children with asthma were randomized to an active art therapy or wait-list control group. Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks. Sessions included specific art therapy tasks designed to encourage expression, discussion, and problem-solving in response to the emotional burden of chronic illness. Measures taken at baseline, immediately after, and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment, the parent and child versions of the Pediatric Quality of Life Asthma Module, and the Beck Youth Inventories. Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions. Score changes from baseline to completion of art therapy indicated (1) improved problem-solving and affect drawing scores; (2) improved worry, communication, and total quality of life scores; and (3) improved Beck anxiety and self concept scores in the active group relative to the control group. At 6 months, the active group maintained some positive changes relative to the control group including (1) drawing affect scores, (2) the worry and quality of life scores, and (3) the Beck anxiety score. Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups. This was the first randomized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life.

Reliability, Validity, and Responsiveness of the Pediatric Quality of Life Inventory™ (PedsQL™) Generic Core Scales and Asthma Symptoms Scale in Vulnerable Children With Asthma

Background. Patient-reported outcomes such as health-related quality of life (HRQOL) are increasingly used as primary endpoints in clinical trials. The Pediatric Quality of Life Inventory™ (PedsQL™) is widely used as a measure of HRQOL and may be a particularly suitable primary outcome in pediatric asthma clinical trials. Objectives. To examine the reliability, validity, and responsiveness to clinical change of the PedsQL™ 4.0 Generic Core Scales and PedsQL™ Asthma Module Asthma Symptoms Scale in a sample of vulnerable children with persistent asthma recruited from Federally Qualified Health Centers. Methods. Children (N = 252; ages 3 to 14 years) with persistent asthma (27% mild, 40.9% moderate, 32.1% severe) and their parents (93.7% mother, 83.3% Hispanic, 76.9% Spanish-speaking, 72.6% less than a high school diploma) enrolled in a clinical trial completed the PedsQL™ 4.0 Generic Core Scales, the PedsQL™ 3.0 Asthma Module Asthma Symptoms Scale, and a measure of asthma symptom frequency (used as an indicator of clinical change) at baseline and 3-month follow-up. Results. The PedsQL™ demonstrated adequate internal consistency reliability and convergent and discriminative validity. Based on intra- and intersubject change, effect sizes, and standard errors of measurement, the PedsQL™ demonstrated responsiveness to clinical change. Conclusions. For both child self-report and parent proxy-report, the PedsQL™ Generic Core Scales Total Scale score and the PedsQL™ Asthma Symptoms Scale are suitable for use as primary asthma clinical trial outcomes.

Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings

Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications. We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0-10, primary outcome); symptoms (1-4); and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1-7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0-100, for children) at 12-month follow-up. Ninety patients (54 adults, 36 children) were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90); eurythmy therapy (22%); art therapy (10%); and rhythmical massage therapy (1%). Median number of eurythmy/art/massage sessions was 12 (interquartile range 10-20), median therapy duration was 120 days (84-184). From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons). Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90-3.32); cough 0.93 (95% CI: 0.60-1.25); dyspnea 0.92 (95% CI: 0.56-1.28); exertion-induced symptoms 0.95 (95% CI: 0.64-1.25); frequency of asthma attacks 0.78 (95% CI: 0.41-1.14); awakening from asthma 0.90 (95% CI: 0.58-1.21); AQLQ overall score 1.44 (95% CI: 0.97-1.92); and KINDL asthma module 14.74 (95% CI: 9.70-19.78). All improvements were maintained until last follow-up after 24 months. Patients with asthma under anthroposophic treatment had long-term improvements of symptoms and quality of life.

Cough affects Quality of Life in asthmatic children aged 8-14 more than other asthma symptoms

BackgroundAsthma may influence children's health-related quality of life (QoL) differently by various symptoms, at different severity. The primary aim of this study was to evaluate the QoL in children with asthma and describe the impact of each asthma symptom on the child's well-being at different severity levels. Material and MethodsTwo hundred randomly selected children and one of their parents who consulted an outpatient asthma clinic, participated in the study. Qol was assessed with DISABKIDS-Smiley measure for children aged 4-7 years and with DISABKIDS DCGM-37 and Asthma Module for children 8-14 year old. ResultsMost of the children suffered from mild or moderate persistent asthma. Children with uncontrolled asthma stated lower QoL compared to partly controlled or controlled in both age groups (p<0.05 in all domains). Cough appeared to affect QoL of 8-14 year olds more than other symptoms, especially in girls. In younger children, sex (boys, p=0.039), age (p=0.045), proxy sex (father, p=0.048), frequency of doctor visits (4-6 months, p=0.001), use of beta-2 agonists (p=0.007) and father's smoking habits (p=0.015) were associated with the QoL of coughing children but no correlation between cough and QoL was detected. In the 8-14 year age group coughers reported lower QoL compared to their counterparts; moreover, cough was found to affect QoL more than other symptoms (p<0.05 in all domains). ConclusionsCough has a direct effect on asthmatic children's QoL but there is still an obvious need for research to reveal all the determinats of this effect.

A Randomized Trial To Test The Effectiveness Of Art Therapy For Children With Asthma

RATIONALE: Art therapy has been used to help children struggling to cope with an illness, but has not been tested in a controlled trial with children who have asthma. METHODS: Twenty three children with asthma were randomized to an active art therapy or wait-list control group. Those in the active art therapy group participated in 60-minute art therapy sessions once a week for seven weeks. Sessions included specific art therapy tasks designed to encourage expression and talk about the burden of chronic illness. Measures taken at baseline, immediately after, and 6 months after the art therapy was completed included the Formal Elements Art Therapy Scale, the Pediatric Quality of Life Asthma Module, and the Beck Youth Inventories. RESULTS: Before and immediately after art therapy comparisons indicated 1) improved problem solving and affect drawing scores; 2) improved worry, communication, and total quality of life scores; and 3) improved Beck anxiety and self concept scores in the active group relative to the control group. At six months, the active group maintained some positive changes relative to the control group including 1) drawing affect scores; 2) worry and communication quality of life scores; and 3) the Beck anxiety score. CONCLUSIONS: This was the first randomized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life.

Self-reported quality of life among inner-city youth with asthma: an empirical examination of the PedsQL 3.0 Asthma Module

Asthma disproportionately affects African American youth and may significantly impair their daily functioning. Although a number of self-reported health-related quality of life (HRQoL) measures have been developed, many rely on parent proxy report rather than youth self-report. Few validity studies have been undertaken to evaluate youth self-report instruments, and studies of economically disadvantaged ethnic minority populations are particularly lacking. To examine the psychometric properties of the PedsQL 3.0 Asthma Module, a widely available self-report index of HRQoL in a sample of inner-city African American youth. Seventy African American youth with asthma (age range, 9-17 years) and their primary caregivers participated. Youth completed the PedsQL 3.0 Asthma Module (developed for youth aged 5-18 years), whereas caregivers provided reports of youth HRQoL, asthma symptoms, health care use, and school absences. Ratings of asthma severity were obtained via physician rating and spirometry. The PedsQL 3.0 Asthma Module total and subscale scores evidenced adequate internal consistency (alpha values >.70), convergent validity with parent proxy ratings of HRQoL and other indexes of functional impairment and differentiated between youth with greater and lesser disease severity. HRQoL can be reliably assessed using the self-report form of the PedsQL 3.0 Asthma Module among 9- to 17-year-old African American youth from economically disadvantaged backgrounds.

Health-related quality-of-life measures for children with asthma: reliability and validity of the Children's Health Survey for Asthma and the Pediatric Quality of Life Inventory 3.0 Asthma Module

Economically disadvantaged African American youth are especially vulnerable to the effects of pediatric asthma and are at increased risk for difficulties in daily functioning. Measures of health-related quality of life (HRQoL) yield important information regarding the impact of pediatric chronic illness on daily functioning. It is essential to develop and validate measures of HRQoL to detect the impact of asthma on this vulnerable population. To examine the psychometric properties of 2 asthma-specific measures of pediatric HRQoL in a sample of economically disadvantaged African American children diagnosed as having asthma. One hundred twenty-seven caregivers completed questionnaires regarding their child's HRQoL, asthma symptoms, health care utilization, and school absences and regarding caregiver emotional distress. The severity of the child's asthma was measured via spirometry. The Children's Health Survey for Asthma and the Pediatric Quality of Life Inventory 3.0 Asthma Module demonstrated adequate internal consistency reliability and validity for the present sample. Lower HRQoL was associated with poorer adherence and more health care utilization, asthma symptom days, school absences, and caregiver distress. Only the Children's Health Survey for Asthma was significantly associated with severity, when defined as airway obstruction. This study supports the psychometric equivalence of 2 condition-specific measures of HRQoL in a population at high risk for asthma and asthma-related problems. The utility of each measure will depend on the needs of the researcher or physician. Both measures can inform the treatment course, help identify and address barriers to treatment adherence, and inform treatment interventions.

Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos

OBJETIVO: Validar o questionário padronizado escrito do International Study of Asthma and Allergies in Childhood, módulo sobre asma, para pesquisa de prevalência de asma, estabelecendo seu escore e a nota de corte para discriminação de adultos asmáticos. MÉTODOS: Entrevistamos pacientes ambulatoriais adultos, 40 asmáticos e 38 controles, pareados por sexo e idade, utilizando o módulo de asma do International Study of Asthma and Allergies in Childhood, composto por oito aspectos dicotômicos de asma. Determinamos o escore e a nota de corte para discriminação de asmáticos, definindo sua sensibilidade, especificidade e índice de Youden. Validamos o método em contraposição ao diagnóstico clínico e funcional. A reprodutibilidade das questões individuais foi testada por meio de reentrevistas de metade dos pacientes após algumas semanas. RESULTADOS: O escore variou de 0 a 14 pontos. Um escore = 5 pontos permitiu discriminar pacientes asmáticos (sensibilidade = 93%, especificidade = 100% e índice de Youden = 0,93). A maioria das questões apresentou boa reprodutibilidade, observada em reentrevista após 48,2 ± 11,1 dias (Kappa e Kappa ponderado variando de 0,43 a 1,00 para as questões individuais). CONCLUSÃO: A validação de uma nota de corte permite uma interpretação alternativa às informações fornecidas pelo módulo de asma do International Study of Asthma and Allergies in Childhood, levando em conta o conjunto das informações e não somente as respostas individuais de cada questão em estudos de prevalência de asma em adultos.

The PedsQL???

We sought to assess the reliability and validity of the PedsQL 4.0 SF15, a shortened version of the 23-item PedsQL 4.0 Generic Core Scales, which is a pediatric health-related quality of life (HRQoL) instrument, and the PedsQL 3.0 SF22 Asthma Module, a short-form of the PedsQL 3.0 Asthma Module. The PedsQL 4.0 SF15 and the PedsQL 3.0 SF22 Asthma Module were administered by telephone to 125 adolescents (aged 12-18) and 338 parents of children with asthma (aged 2-11). Healthy (n = 451) and chronically ill (n = 422) children, matched by age, respondent status, and ethnicity to the asthma sample, provided data for selected validity tests. The Total Score from the PedsQL 4.0 SF15 and the Asthma Symptoms scale and Treatment Problems scale from the PedsQL 3.0 SF22 Asthma Module were sufficiently reliable for group comparisons (alpha > or = 0.70 across all age groups) in the asthma sample. The PedsQL 4.0 SF15 and the PedsQL 3.0 SF22 Asthma Module were able to distinguish between children of different clinical status and correlated as expected with measures of productivity and family functioning in the asthma sample. The psychometric properties of the PedsQL 4.0 SF15 were generally comparable to those of the original instrument. The Total Score of the PedsQL 4.0 SF15 and the Asthma Symptoms scale of the PedsQL 3.0 SF22 Asthma Module demonstrated the best reliability and validity and should be suitable for group-level comparisons of generic and asthma-specific HRQoL in clinical research studies of children with asthma.

The PedsQL in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory generic core scales and asthma module.

The PedsQL is a modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents ages 2-18. The PedsQL 4.0 Generic Core Scales were developed to be integrated with the PedsQL Disease-Specific Modules. The PedsQL3.0 Asthma Module was designed to measure pediatric asthma-specific HRQOL. The PedsQL was administered to 529 families. Internal consistency reliability was demonstrated for the PedsQL 4.0 Total Score (alpha = 0.90 child, 0.91 parent report) and Asthma Module (average alpha = 0.71 child, 0.86 parent report). The PedsQL 4.0 distinguished between healthy children and children with asthma. The validity of the PedsQL Asthma Module was demonstrated through intercorrelations with a previously standardized asthma disease- specific instrument. Responsiveness was demonstrated through patient change over time as a result of clinical intervention. The results demonstrate the reliability, validity, and responsiveness of the PedsQL required for an outcome measure in pediatric asthma clinical trials and research.

Learning management systems: technology to measure the medical knowledge competency of the ACGME.

We report how the learning management system (LMS) Web Course Tools (WebCT) was used to design, implement and evaluate the web-based course "Principles of Ambulatory Paediatrics", taken by paediatric residents during an ambulatory block rotation. This report also illustrates how WebCT can be used to measure the medical knowledge competency required by the Accreditation Council for Graduate Medical Education (ACGME). Eighty paediatric residents completed a 1-month outpatient rotation between July 1, 2001 and June 30, 2002. During this rotation residents were required to complete 4 modules in asthma, otitis media, gastroenteritis and fever, respectively. Each module was evaluated using a standard questionnaire. Completion rates for the required modules ranged from 64-72%. Residents in all 3 years of training showed improvement between the pre- and post-test scores for each module, except for postgraduate Year 2 residents in the asthma module. Most residents somewhat agreed, agreed or strongly agreed that the module components were useful and that the experience of completing the modules would improve their ability to take care of patients. The LMS WebCT is an innovative and adaptable approach for designing a web-based course for primary care education in paediatrics. The LMS addresses the educational needs of both a clinical division and a residency programme. The LMS also provides an information technology infrastructure to measure the medical knowledge competency required by the ACGME.

Akinbami and Schoendorf Respond to "Asthma Surveillance in US Children": The Challenge of Asthma Surveillance and Continuous Health Surveys

Drs. Lanphear and Gergen (1) correctly point out that there are many challenges in conducting asthma surveillance and that continuous improvement in national asthma surveillance is needed. They also point out that the data collection systems of the National Center for Health Statistics are the cornerstone of many national surveillance systems. They go on to identify several shortcomings of the National Health Interview Survey (NHIS), one component of the asthma surveillance system. Most of these shortcomings are directly related to the complexities of asthma surveillance in particular but also reflect challenges in operating any ongoing data collection system. Maintaining continuous data collection is a major objective of the NHIS. However, to keep the NHIS useful for its many purposes, it was essential that the survey be redesigned to reduce respondent burden and thus preserve high response rates, to utilize new interviewing technology, to simplify the NHIS data set for increased ease of use by researchers, and to incorporate new medical knowledge. There is no good time to redesign a survey; issues of a break in trend are always of concern. However, what is lost in data comparability can be gained in improved quality and, indeed, the redesign in many ways improved asthma surveillance. For example, prior to the redesign, the NHIS did not require a physician diagnosis for the case definition of asthma. Starting with the 1997 redesign, asking about physician diagnosis was one important change made for all chronic conditions to improve data quality. The 1997–2000 NHIS did indeed have some shortcomings for asthma surveillance beyond the interruption of the trend. As discussed in our article (2), from 1997 through 2000, the core survey did not include a question about current asthma, but focused on asthma attacks or episodes. In 2001, a question about current asthma was added to fill this gap. Data from the 2001 NHIS for asthma prevalence are available on the National Center for Health Statistics Internet page (http://www.cdc.gov/nchs/products/pubs/pubd/ hestats/asthma/asthma.htm). Starting in 2001, the four asthma questions in the NHIS core (lifetime diagnosis, current asthma, recent asthma attacks, and emergency room visits for asthma) are identical to the asthma questions in the National Health and Nutrition Examination Survey, as recommended by Drs. Lanphear and Gergen. Also as suggested by Drs. Lanphear and Gergen, additional questions about asthma medications, patient education, and hospitalization are included in periodic topical modules. The 1999 NHIS included a topical asthma module that also contained questions about symptoms of wheezing, allowing the rate of asthma diagnosis among symptomatic people to be measured. The national asthma surveillance system of the Centers for Disease Control and Prevention comprises several surveys and data systems: the NHIS, the Behavioral Risk Factor Surveillance System, the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System. Although each data source has its strengths and weaknesses, taken together, the asthma surveillance system of the Centers for Disease Control and Prevention provides a broad view of the impact of asthma in the United States. Furthermore, this system, along with the National Health and Nutrition Examination Survey, provides rich information that has been widely utilized in research on asthma. The National Center for Health Statistics and other Centers in the Centers for Disease Control and Prevention have been working to improve and augment existing asthma surveillance. One area of particularly high interest is