TY - JOUR
T1 - No symptoms, no asthma
T2 - The acute episodic belief is associated with poor self-management among inner-city adults with persistent asthma
AU - Halm, Ethan A.
AU - Mora, Pablo
AU - Leventhal, Howard
N1 - Funding Information:
This study was funded by the Agency for Healthcare Research and Quality (RO1 HS09973) and the United Hospital Fund (010608B).
Funding Information:
Dr. Halm was also supported by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2006/3
Y1 - 2006/3
N2 - Objective: Asthma morbidity and mortality is highest among inner-city populations. Suboptimal beliefs about the chronicity of asthma may perpetuate poor asthma control among inner-city asthmatics. This study sought to characterize beliefs about the chronicity of disease and its correlates in a cohort of inner-city adults with persistent asthma. Design: Prospective, longitudinal, observational cohort study. Patients: One hundred ninety-eight adults hospitalized with asthma over a 12-month period at an inner-city teaching hospital. Measurements: Sociodemographics, clinical history, disease beliefs, and self-management behaviors were collected by interview. Information on self-reported use of inhaled corticosteroids (ICS), peak flowmeters, and regular asthma visits was collected during hospitalization, and 1 month and 6 months after discharge. Results: This cohort was predominantly low income and nonwhite, with high rates of prior intubation, oral steroid use, and emergency department visits and hospitalizations. Overall, 53% of patients believed they only had asthma when they were having symptoms, what we call the no symptoms, no asthma belief. Men patients, those ≥ 65 years old, and those with no usual place of care had greater odds of having the no symptoms, no asthma belief, and those receiving oral steroids all or most of the time or with symptoms most days had half the odds of having this belief (p < 0.05 for all). The no symptoms, no asthma belief was negatively associated with beliefs about always having asthma, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. The acute disease belief was associated with one-third lower odds of adherence to ICS when asymptomatic at all three time periods (p < 0.02 for all). Conclusion: The single question, "Do you think you have asthma all of the time, or only when you are having symptoms?" can efficiently identify patients who do not think about or manage their asthma as a chronic disease.
AB - Objective: Asthma morbidity and mortality is highest among inner-city populations. Suboptimal beliefs about the chronicity of asthma may perpetuate poor asthma control among inner-city asthmatics. This study sought to characterize beliefs about the chronicity of disease and its correlates in a cohort of inner-city adults with persistent asthma. Design: Prospective, longitudinal, observational cohort study. Patients: One hundred ninety-eight adults hospitalized with asthma over a 12-month period at an inner-city teaching hospital. Measurements: Sociodemographics, clinical history, disease beliefs, and self-management behaviors were collected by interview. Information on self-reported use of inhaled corticosteroids (ICS), peak flowmeters, and regular asthma visits was collected during hospitalization, and 1 month and 6 months after discharge. Results: This cohort was predominantly low income and nonwhite, with high rates of prior intubation, oral steroid use, and emergency department visits and hospitalizations. Overall, 53% of patients believed they only had asthma when they were having symptoms, what we call the no symptoms, no asthma belief. Men patients, those ≥ 65 years old, and those with no usual place of care had greater odds of having the no symptoms, no asthma belief, and those receiving oral steroids all or most of the time or with symptoms most days had half the odds of having this belief (p < 0.05 for all). The no symptoms, no asthma belief was negatively associated with beliefs about always having asthma, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. The acute disease belief was associated with one-third lower odds of adherence to ICS when asymptomatic at all three time periods (p < 0.02 for all). Conclusion: The single question, "Do you think you have asthma all of the time, or only when you are having symptoms?" can efficiently identify patients who do not think about or manage their asthma as a chronic disease.
KW - Adherence
KW - Asthma
KW - Behaviors
KW - Beliefs
KW - Knowledge
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U2 - 10.1378/chest.129.3.573
DO - 10.1378/chest.129.3.573
M3 - Article
C2 - 16537854
AN - SCOPUS:33645123212
SN - 0012-3692
VL - 129
SP - 573
EP - 580
JO - CHEST
JF - CHEST
IS - 3
ER -