Asthma-specific Panic-Fear - Role of Informant Report on Morbidity Outcomes

Abstract

Objective: The purpose of this study was to examine whether caregiver or the child's perception of the child's asthma-specific panic-fear was a better indicator of asthma morbidity outcomes and perception of respiratory symptoms. Additionally the study examined the relationship between informant report of the child's asthma-specific panic-fear and measures of trait anxiety. Method: 125 caregiver-child dyads were recruited primarily from outpatient clinics. Ratings of asthma-specific-panic-fear were obtained using the child (CASCL) and caregiver (PCASCL) versions of the Childhood Asthma Symptom Checklist. Symptom perception data were obtained by comparing the children's predictions of their peak expiratory flow to their actual values across a 6-week period. Reports of asthma-related missed school days, ER visits, hospitalizations, doctor visits, and steroid bursts were obtained by caregiver report. Current caregiver anxiety disorder was determined through a clinician administered diagnostic interview using the SCID. Child rating of current anxiety was obtained using the self-administered Multidimensional Anxiety Scale (MASC). Results: After controlling for child age, child gender, and asthma severity, child report of asthma-specific panic-fear during an asthma attack predicted need for steroid burst treatment, OR = 1.54, 95% CI [1.03, 2.31], p = .037. Children with higher ratings of asthma-specific panic-fear were significantly more likely to over perceive their respiratory symptoms, R2 Change = .097, t (91) = 3.15, p = .002, and less likely to under perceive their respiratory symptoms, R2 Change = .098, t (91) = -3.25, p = .002. Additionally, children with higher trait anxiety were more likely to report higher asthma-specific panic-fear, R2 Change = .105, t (111) = 3.64,p < .001. Higher parent report of child asthma-specific panic-fear was associated with worse asthma control, OR = 2.22, 95% CI [1.37, 3.601, p = .001. Parents with a current anxiety disorder were more likely to report higher asthma-specific panic-fear in their children, R2 Change = .102, t (112) = 3.58, p = .001. Parent report of the child's asthma-specific panic-fear was not associated with other measures of asthma morbidity or with child symptom perception data. Conclusion: The findings from the current study suggest that the internal and observable aspects of panic experienced by the child during an asthma attack are independent from one another and are related to different asthma outcomes. More importantly the results demonstrate associations between higher state anxiety and both less under perception and increased over perception of respiratory symptoms. Additionally, the findings demonstrate a relationship between parent report of higher panic fear in their children during an asthma attack and worse asthma control. Therefore the presence of state anxiety may serve an adaptive process and be related to an increased sensitivity to respiratory symptoms. On the other hand higher state anxiety may be maladaptive and be associated with increased report of subjective impairment and need for steroid medication.