Table 2 Summary of asthma signs/symptoms and impacts reported during concept elicitation in Round 1, 2, and 3 interviews (N = 45)

Asthma sign/symptoms

Cough (N = 45/45, 100%)

Child 8–11 y.o. (n = 15/15, 100%)

Caregiver of child 4–11 y.o. (n = 30/30, 100%)

06-20-M-8-WC-P: “…I would really like start coughing, like coughing real bad…I will really cough a lot…and I'll like need my…asthma pump…”

11-30-F-34-WC-CG: “She will just cough all day when it's real bad. Um, there have been times at night where she will cough and keep her up, uh, cough to the point of throwing up.”

Difficulty breathing (N = 45/45, 100%)

Child 8–11 y.o. (n = 15/15, 100%)

Caregiver of child 4–11 y.o. (n = 30/30, 100%)

27-40-F-11-NWC-P: “Asthma, it's hard to breathe. It's like when you can't do much things 'cause it's hard to breathe…”

09-20-F-35-NWC-CG: “Well typically she'll always, um, grab her chest or around her throat area and say that it's difficult to breathe or she's having a hard time breathing…”

Wheezing (n = 44/45, 97.8%)

Child 8–11 y.o. (n = 14/15, 93.3%)

Caregiver of child 4–11 y.o. (n = 30/30, 100%)

18-50-M-9-NWC-P: “I hear a loud wheezing noise.”

19-40-F-31-WC-CG: “…So he usually has like wheezing and short of breath, um, especially like certain times of the night sometimes. And also like if he's, um, at school and he's doing too much activity or something, he can experience symptoms like that.”

Shortness of breath (n = 42/45, 93.3%)

Child 8–11 y.o. (n = 14/15, 93.3%)

Caregiver of child 4–11 y.o. (n = 28/30, 9.33%)

23-40-M-9-NWC-P: “Uh, I get out of breath quickly.”

08-40-F-38-NWC-CG: “…He has a hard time kind of just catching his breath, um, just seems out of breath.”

Chest tightness (n = 19/45, 42.2%)

Child 8–11 y.o. (n = 15/15, 100%)

Caregiver of child 4–11 y.o. (n = 4/30, 13.3%)

09-20-F-10-NWC-P: “My chest tighten up.”

15-40-F-40-WC-CG: “…Um, he feels from what I can see and what he can describe is like a tightness of the chest. So kind of like the, the walls of his body kind of closing in.”

Domains of impacts on daily life

Physical activity (N = 45/45, 100%)

Child 8–11 y.o. (n = 15/15, 100%)

Caregiver of child 4–11 y.o. (n = 30/30, 100%)

10-40-F-9-WC-P: “…you can't, you can't like play like a normal person. Like you can't like play without having to stop to take your pump or something.”

23-40-F-36-NWC-CG: “If just—if he’s not feeling well, then there’s just—he can’t go play or run.”

Sleep (n = 44/45, 97.8%)

Child 8–11 y.o. (n = 15/15, 100%)

Caregiver of child 4–11 y.o. (n = 29/30, 96.7%)

27-40-F-11-NWC-P: “Well like sometimes I wake up from my sleep like more than once a week. Like I just wake up 'cause it's like, like I can't breathe when I'm sleeping. So I wake up.”

09-20-F-35-NWC-CG: “Um, yes. There has been times that it has been very difficult for her to go to sleep, um, especially when she's having a really, really bad flare-up…”

Social functioning (n = 18/45, 40.0%)

Child 8–11 y.o. (n = 7/15, 46.7%)

Caregiver of child 4–11 y.o. (n = 11/30, 36.7%)

03-40-M-8-WC-P: “Uh, the worst thing is that like if like it's—um, so like in the summertime, if I play with my friends and my family and we usually run around if we're having like a water balloon fight or water gun fight. That I have to take a break and I can't play anymore until like it goes away and starts to slow down.”

23-40-F-36-NWC-CG: “…Um, I mean there's times that he can't do things that he likes to do as a kid, you know, in school trying to play with his friends. And when he's not feeling well, he just doesn’t.”

Emotional wellbeing (n = 17/45, 37.8%)

Child 8–11 y.o. (n = 5/15, 33.3%)

Caregiver of child 4–11 y.o. (n = 12/30, 40.0%)

13-10-M-11-NWC-P: “When I do wheeze, it makes like—to me it makes a loud noise, like again a whistle noise. And it will—sometimes it will scare me because when, uh, I do wheeze that means I again have trouble breathing.”

20-50-F-24-NWC-CG: “Um, where he is short of breath, where he's to the point where he's crying because he's—I guess it's like an anxiety feeling for him where he can't breathe.”

School (n = 4/45, 8.9%)

Child 8–11 y.o. (n = 3/15, 20.0%)

Caregiver of child 4–11 y.o. (n = 1/30, 3.3%)

14-10-M-8-NWC-P: “About my breathing well and not going to school because I can't go to school because I'm sick of the asthma.”

Interviewer: “…how do these symptoms affect your child?” 23-40-F-36-NWC-CG: “Um, with his school work. You know, trying to focus sometimes.”