Do Children and Parents Agree on the Level of Asthma Control? A Systematic Review

BACKGROUND: Asthma is a prevalent chronic condition in children, and is often not sufficiently controlled. Children and parents may have a different interpretation of the level of asthma control, which can lead to suboptimal treatment. This systematic review aims to synthesize literature regarding concordance between children and their parents in the perception of asthma control. METHODS: A systematic literature search was conducted in EMBASE, MEDLINE, Web of Science, and Google Scholar up to February 5, 2025. Studies were included if they involved children aged 4-18 with asthma and their parents, assessed asthma control using questionnaires validated for children or derived from guidelines, and compared results of children and their parents. All healthcare settings were included. Four reviewers independently screened the studies and two extracted the data. Methodological quality was assessed using the Newcastle Ottawa Scale. RESULTS: Nine publications were included, with a total of 1,693 children and 1,693 parents. Various questionnaires and guidelines were used to assess asthma control. The quality of the majority of the studies was rated satisfactory or good. The agreement between children and parents ranged from weak to very good. In many cases, there was a significant difference between the answers of the children and their parents: children often perceived their asthma to be less controlled compared to their parents. DISCUSSION: The perception of asthma control is frequently discordant between children and parents, with children often reporting lower levels of asthma control. These findings highlight the importance and potential beneficial effects of shared decision-making between children, caregivers, and healthcare providers in improving treatment outcomes.