Negative affect including depression is known to be associated with asthma control, but whether and how it influences control in children with asthma is not understood.

The objective of this investigation was to evaluate whether negative affect and medication nonadherence each predict decreased symptom control, and whether the relationship between negative affect and disease control is explained by children’s adherence to asthma medications.

Participants included 104 children 8 to 18 years old being treated with an inhaled corticosteroid delivered by metered-dose inhaler for asthma diagnosed by their health care providers. Children and parents independently rated asthma symptoms and completed questionnaires assessing sad and anxious affect. Electronic devices were attached to each participant’s metered-dose inhaler to measure adherence. At study completion, records were collected to confirm reports of health events.

Both child and parent negative affect scores predicted symptom scores, whether reported by child or parent, and child negative affect scores predicted school absence because of asthma. In a lagged analysis taking into account time sequence, medication adherence predicted prednisone bursts but not subjective symptom scores. Nonadherence did not explain the relationship between negative affect and symptom scores, but parent negative affect predicted prednisone bursts even when controlling for level of adherence.

Although both negative affect and adherence were predictive of asthma control, the relationship of each to asthma control was distinctly different. Accuracy of symptom perception may be influenced by patient and parent affect characteristics.