Chest
Original Research: ASTHMANo Symptoms, No Asthma: The Acute Episodic Disease Belief Is Associated With Poor Self-Management Among Inner-City Adults With Persistent Asthma
Section snippets
Study Participants
The cohort study has been described previously.20 We prospectively identified an inception cohort of all adults hospitalized for asthma at a 1,100-bed university teaching hospital in New York City during a consecutive 12-month period (September 2001 through September 2002). The hospital is the largest provider of care for the East Harlem community. Computerized hospital admission logs were used to identify all adults with a primary or secondary admission diagnosis of asthma (International
Patient Participation and Response Rates
During the study period, there were 384 hospitalizations with a primary or secondary diagnosis of asthma; 335 were confirmed asthma admissions among 250 unique patients. Of these, 218 patients met eligibility criteria, and 204 patients (94%) consented to participate. Reasons for exclusion were as follows: readmissions among study participants (n = 85), active psychiatric problems (n = 9), and admitted/discharged on the same weekend (n = 23). Of the 204 who consented, 198 patients (97%)
Discussion
In this study of a cohort of high-risk, inner-city adults hospitalized for asthma, underlying beliefs about the chronicity of disease, on which all guideline recommended care is based, varied widely. The most striking finding was that over half of the patients had the no symptoms, no asthma disease belief, suggesting that they think about their disease as an acute episodic illness. Our confidence that we have identified a dominant, deeply held, acute episodic disease belief is strengthened by
ACKNOWLEDGMENT
The authors would also like to thank Allison Cooperman, MPH, Jason Wang, PhD, Jessica Salazar, Lisa Fitzgerald, BA, Toni Sturm, MD, and Juan Wisnivesky, MD, MPH, for their contribution to the project, as well as the patients and their physicians for their goodwill and cooperation.
References (41)
- et al.
The health economics of asthma and rhinitis: I. Assessing the economic impact
J Allergy Clin Immunol
(2001) - et al.
Adherence to asthma therapy
Ann Allergy Asthma Immunol
(2001) - et al.
Improving patient compliance with asthma therapy
Respir Med
(2000) - et al.
Compliance in asthma
Respir Med
(1999) - et al.
Inadequate outpatient medical therapy for patients with asthma admitted to two urban hospitals
Am J Med
(1996) - et al.
Controlled evaluation of the effects of patient education on asthma morbidity in general practice
Lancet
(1986) - et al.
A controlled trial of two forms of self-management education for adults with asthma
Am J Med
(1993) - et al.
Quality and access to care among a cohort of inner city adults with asthma: who gets guideline concordant care?
Chest
(2005) - et al.
Allergen sensitization evaluation and allergen avoidance education in an inner city adult cohort with persistent asthma
J Allergy Clin Immunol
(2005) - et al.
Medication, chronic illness and identity: the perspective of people with asthma
Soc Sci Med
(1997)
Inhaled corticosteroids for asthma: are ED visits a missed opportunity for prevention?
Am J Emerg Med
Surveillance for asthma: United States, 1980–1999
Morb Mortal Wkly Rep CDC Surveill Summ
The challenge of inner-city asthma
Curr Opin Pulm Med
Asthma mortality in U.S. Hispanics of Mexican, Puerto Rican, and Cuban heritage, 1990–1995
Am J Respir Crit Care Med
Variations in asthma hospitalizations and deaths in New York City
Am J Public Health
Asthma hospitalization and mortality in New York City, 1987–1996
Hispanic health in the United States.. Council on Scientific Affairs
JAMA
Budesonide at different doses for chronic asthma
Cochrane Database Syst Rev
National Heart, Lung and Blood Institute
Expert panel report 2: Guidelines for the diagnosis and management of asthma.
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2022, Social Science and MedicineCitation Excerpt :Second, over-perception occurs when patients have higher sensitivity to sensations of bronchoconstriction or misinterpret breathing difficulties caused by exercise, deconditioning, or panic as asthma, leading to over-use of medication (De Peuter et al., 2008; Main et al., 2003). Third, the “no symptom, no asthma” phenomenon occurs when patients and caregivers interpret a lack of symptoms as an absence of disease, counter to biomedical models of asthma as a chronic disease requiring maintenance medication even when asymptomatic (Halm et al., 2006). These three phenomena, which may be influenced by socio-cultural and psychological factors, may contribute to mismatches between provider and caregiver conceptual models, resulting in providers using biomedical tools (e.g., spirometry) to try to convince caregivers that their child is indeed sick.
Symptom Perception and Interpretation
2022, Comprehensive Clinical Psychology, Second Edition
This study was funded by the Agency for Healthcare Research and Quality (RO1 HS09973) and the United Hospital Fund (010608B).
Dr. Halm was also supported by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program.
An earlier version of these results were presented at the American Thoracic Society meeting on May 18, 2003.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).