Patient view of asthma as a temporary health problem negatively impacts control of disease

Over half of adults with serious asthma believe they only have asthma when they have symptoms and these individuals are significantly less likely to take necessary medications during asymptomatic periods, according to a study in the March issue of Chest.

Asthma is a chronic lung condition characterized by difficulty breathing that affects over 20 million Americans. While asthma is one of the most common chronic conditions in the US, it is particularly prevalent among inner city populations. East Harlem, where the study was conducted, is one of the communities hardest hit by asthma in the country and in New York City.

"We surveyed 198 adult patients hospitalized with asthma about their beliefs and behaviors regarding their disease," said Ethan Halm, MD, MPH, Associate Professor of Medicine at Mount Sinai School of Medicine and lead author on the study. "More than half of them thought they only had asthma when they were having symptoms. They are treating asthma more like a cold or flu that will go away between attacks, than as the serious, chronic disease which it is.

Dr. Halm and his colleagues from Mount Sinai and from Rutgers University labeled this the "no symptoms, no asthma" belief. Patients who thought this way were one third less likely to take their asthma medication daily. "This is particularly troubling because daily use of anti-inflammatory medications is proven to improve asthma control, reduce rates of hospitalizations, and is the cornerstone of guideline recommended best practice." said Dr. Halm.

Forty percent of the patients believed they had chronic asthma, while six percent thought they had asthma some of the time. When asked about the lifelong nature of asthma, 20 percent of patients felt they would not always have asthma and 15 percent expected the doctor to cure them of asthma. Male patients, those over 65 years old, and patients with no usual place of care were more likely to hold the "no symptoms, no asthma" belief.

"Our findings suggest that there may be a fundamental disconnect between how patients and physicians think about and manage asthma. As clinicians, we need to find better ways to uncover patients underlying health beliefs as a critical first step in trying to help them understand and treat their asthma as a serious but controllable chronic disease." said Dr. Halm. "We need to find ways to tailor our educational efforts to individual beliefs and behaviors if we are to make headway in improving outcomes for our patients and reducing costs to the system."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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