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Asthma Patients Misunderstand Symptoms

March 13, 2006 -- Focusing too much on asthma symptoms may be a problem for some asthma patients, researchers report in Chest.

Here are some of the views voiced in a yearlong study of nearly 200 adults hospitalized with asthma:

• I only have asthma when I have asthma symptoms: 53% agreed.
• I won't always have asthma: 20% agreed.
• My lungs are always a bit inflamed or irritated: 54% agreed.

The researchers included Ethan Halm, MD, MPH, an associate professor of medicine at Mount Sinai medical school in New York City.

"Our findings suggest that there may be a fundamental disconnect between how patients and physicians think about and manage asthma," Halm says in a news release.

Temporary Asthma?

Asthma is a big problem in inner cities. That's why Halm's team focused on asthma patients at an inner-city hospital in New York City.

In interviews, the researchers asked participants four questions:

• Do you think you have asthma all of the time or only when you are having symptoms?
• Do you think you will always have asthma?
• Do you think you have asthma because your lungs are always a bit inflamed or irritated?
• Do you expect the doctor to cure you of your asthma?

Participants could answer "Definitely," Probably," "Possibly," or "No." They also reported how regularly they cared for their asthma by using treatments such as inhaled corticosteroids.

'No Symptoms, No Asthma' Belief

More than half of the patients indicated that they thought they didn't have asthma when they didn't have asthma symptoms. Halm's team dubbed that misunderstanding the "no symptoms, no asthma" belief.

Patients expressing that belief stated that it was important to treat asthma symptoms. But they were less likely to emphasize treatment when asthma symptoms weren't present.

Those patients were also more likely to agree that they wouldn't always have asthma; that their lungs weren't always a bit inflamed or irritated, and that they expected doctors to cure their asthma.

Men, elderly patients, and those without a regular place of medical care were more likely to voice those views, write the researchers. This study only looked at inner-city people who were hospitalized for asthma. The researchers add that more studies are needed to see if the findings apply to other groups of asthma patients.

Setting the Record Straight

Patients who see asthma as a fleeting problem might need more coaching about self-treatment, the researchers note.

They suggest that doctors ask asthma patients, "Do you think you have asthma all of the time, or only when you are having symptoms?" and offer this advice:

"It is important that you understand that you have your asthma all of the time, even when you are feeling well. That is why it is so important to use your [name of inhaled corticosteroid] every day, twice a day, whether you are feeling good or bad, to help cool off the inflammation in your lungs and keep your asthma from acting up."

Doctors can often help patients learn to cope with asthma, which is a chronic condition.

It might be worthwhile to do similar studies on other chronic diseases in which people don't always feel sick, including high blood pressure, diabetes, and congestive heart failure, note Halm and colleagues.