Chest
Volume 117, Issue 2, February 2000, Pages 434-439
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Clinical Investigations
Perceptions of Asthma by Adolescents at Home

https://doi.org/10.1378/chest.117.2.434Get rights and content

Objectives

To test symptom perception in asthma under natural circumstances and to establish relationships between changes in airway obstruction as indicated by wheeze, dyspnea, general sensations, and emotional state.

Design

Continuous in vivo monitoring.

Method

Symptom perception was tested in 30 adolescents with severe, unstable asthma. They were continuously monitored in their homes for 72 h. Symptom perception was defined as the relation between self-reported dyspnea and airway obstruction as evident from audible wheeze. Tracheal sounds were continuously recorded with wireless telemetry for wheeze assessment. Dyspnea was assessed four times per day on a Likert-type 10-point scale, as well as four times randomly after pager remote command. The subjects kept records of use of medication, daily activities, general symptoms, and mood state in a diary.

Results

There were nine subjects with one or two wheeze episodes, another three subjects with three or four episodes, and one subject with almost continuous wheeze. The presence of wheeze in general related significantly to a rise (from individual baseline) in dyspnea of> 2.5 scale points. Acute wheeze was the best predictor of a rise in dyspnea, but prolonged wheeze correlated significantly with negative mood and general symptoms.

Conclusion

Patients with prolonged airway obstruction perceived symptoms less well and were more vulnerable to negative effects of asthma than patients with acute onset airway obstruction.

Section snippets

Subjects

There were 30 adolescents with asthma participating, 18 boys and 12 girls, aged 13 to 17 years (mean, 14.3; SD, 2.1). They enrolled via general physicians in Amsterdam and received equal payment for their participation. All subjects and their parents signed informed consent.

The severity of asthma was evaluated according to the guidelines of asthma management by the British Thoracic Society et al.36, 37 The subjects were using medication from “steps four and five,” indicating severe asthma: oral

Results

There were nine subjects with one or two wheeze episodes, another three subjects with three or four wheeze episodes, and one subject with almost continuous wheeze. None of the subjects needed emergency care during the monitoring period.

The 30 subjects completed 234 dyspnea assessments, of which 2 were not used in the analysis because they had been preceded by bronchodilator inhalation. The mean dyspnea was 1.8 (range, 0 to 6; SD, 1.7). The mean dyspnea during wheeze episodes (n = 13; 32

Discussion

This study showed that spontaneous airway obstruction as indicated by wheeze in the homes of asthmatics related significantly to a dyspnea rise from baseline of ≥ 2.5 scale points. Acute wheeze predicted dyspnea better than did prolonged wheeze. However, only dyspnea during prolonged wheeze correlated significantly with negative mood and general symptoms.

These preliminary results suggested that adolescents with prolonged airway obstruction were more vulnerable to negative effects of asthma than

Acknowledgments

The authors thank Cedric Sands for proofreading the manuscript.

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    This study was financially supported by the Netherlands Asthma Foundation.

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