Asthma Severity and Asthma Control---Influence of Psychological Factors in Medication Adherence and Morbidity
Lupkin, Michelle I.
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Objective: The goal of this study was to examine the relationships between asthma-specific panic-fear and irritability and the subjective and objective components of asthma control and asthma severity. This study also examined whether differences between level of pulmonary function and level of subjective reports of symptoms would be associated with adherence to controller medication, reports of emergency room (ER) visits, PRN beta 2 agonist medication, missed days of school due to asthma, and use of oral corticosteroids. Method: Two-hundred-fourteen parent-child dyads were recruited primarily from outpatient clinics in the Bronx that predominately serve families of low socioeconomic status. Ratings for asthma severity and asthma control were performed based on National Heart, Lung, and Blood Institute (2007) criteria. Relationships between asthma specific-panic-fear and irritability and subjective and objective components of control and severity were examined using the Childhood Asthma Symptom Checklist and the parent version of this measure. Comparisons between level of pulmonary function and level of caregiver report of asthma symptoms were performed and used to explore relationships with adherence to controller medication and asthma morbidity. Results: After controlling for asthma severity, caregivers who over reported their child's asthma symptoms compared to the their child's lung function were more likely to be frequent users of PRN beta2 agonist medication (OR=5.85; 95% CI, 2.27-15.08, p<.0005) and to miss more days of school due to asthma (OR=4.60; 95% CI, 1.82- 11.58, p=.001) as compared to participants who under reported symptoms relative to lung function. Over reporters were also more likely to have an ER visit in the past four weeks compared to accurate and under reporters (OR=3.34; 95% CI. 1.16-9.64, p=.025). No between groups differences were found in asthma-specific panic-fear and irritability by level of asthma severity and only child report of asthma-specific irritability showed differences by level of asthma control [F(2,210)=3.09, p=.047]. Between-group differences were found in parent perception of asthma-specific panic-fear [F(2,210)=4.99, p=.008] and irritability [F(2,210)=5.39, p=.005] by level of subjective report of asthma symptoms. However, no differences were found in asthma-specific panic-fear and irritability by level of pulmonary function. No significant differences were found in mean scores on the child and parent versions of the Childhood Asthma Symptom Checklist between those who over reported, under reported or accurately reported (congruent) asthma symptoms as compared to lung function. Rates of adherence to controller medication did not differ between over, under and congruent reporters. Conclusion: Asthma-specific panic fear and irritability were strongly associated with subjective reports of asthma symptoms, but not objective measures of pulmonary function. Type of reporter (over, under, congruent) was a robust predictor of asthma morbidity.