Dyspnea Perception in Pediatric Asthma Patients: The Relationship Between Symptom Perception and Asthma Morbidity, Caregiver Illness Representation and Caregiver Nativity

Abstract

Background: Dyspnea is a subjective experience of discomfort or difficulty breathing and can vary in quality and intensity. It is common to all respiratory illnesses, including asthma Dyspnea has both sensory and affective components that are related but distinct dimensions. Perception of dyspnea is an important element to proper asthma management and self-care. The purpose of this study was to assess the relationship between perception of dyspnea as it relates to asthma morbidity outcomes, caregiver beliefs about asthma as well as caregiver nativity.;Methods: Participants were 156 children with asthma (age M = 10.14 +/- 2.01) and their caregivers recruited from inner-city hospitals. The study included Puerto Rican (n = 82), African American (n = 45), and Black Caribbean (n = 29) participants. Caregivers completed of number of measures to assess demographic and related information, as well as measures related to their child's asthma management including the Asthma Functional Severity Scale (AFSS). Caregivers also answered questions about the child's asthma over the past month and year to assess morbidity including information about oral corticosteroid use, emergency department (ED) visits and overnight hospitalizations. Children completed spirometry and were taught how to complete Modified Borg Scale ratings (MBS). Children were given an electronic peak flow meter to use for 5-6 weeks at home and were asked to complete MBS ratings prior to completing their peak flow. Statistical methodologies used to assess the relationship between MBS and morbidity outcomes and caregiver illness beliefs included hierarchical multiple regressions and binary logistic regressions. Age and asthma severity (based on NHLBI guidelines) were controlled for in all analyses.;Results: The Sensory Borg Measure Accuracy Index ranged from -.55---.44 (M=-0.06, SD=.23). The Affective Borg Measure Accuracy Index ranged from -.76--.32 (M= -0.09, SD=.23). Neither the Affective nor the Sensory Borg Index was significantly correlated with the Asthma Functional Severity Scale Total Score (completed at the follow-up session). More accurate perception of symptoms was related to an increased amount of emergency room visits, as measured by the Sensory Borg Accuracy Index (OR=.17, 95 % CI. =.03, .95, p=.04) and Affective Borg Accuracy Index (OR=.18, 95 % CI= .04, .81, p=.03) when controlling for age and asthma severity. Better perception measured by the Sensory Borg Index was also linked to a greater number of oral corticosteroid bursts (OR=.65, 95 % CI= .04, .74, p=.02). No relationship was found between the Borg Accuracy Indexes and overnight hospitalizations, parental asthma beliefs, or caregiver nativity.;Discussion: Several theories exploring why the children with more accurate perception of dyspnea have increased morbidity outcomes are explored. More specifically, these findings suggest that for children who are accurate in their perception of dyspnea, it may in fact serve an adaptive purpose. This population largely comprised of children recruited from inner city clinics and hospitals who have been diagnosed with severe-persistent and moderate-persistent asthma (approximately 85%). For these children with severe asthma, accurate perception may help these children get the critical interventions they require. These results could also be indicative of some type of learning effect that tends to occur in children with more severe asthma/symptoms. Implications for the continued care of pediatric asthma patients are discussed.