Perception of airflow obstruction in patients hospitalized for acute asthma.
ABSTRACT Little is known about the perception of airflow obstruction in patients hospitalized for acute asthma.
To evaluate patient perception of airflow obstruction at hospital discharge and at a 2-week follow-up visit and to determine whether symptom control and/or severity of airflow obstruction identified patients at risk for acute asthma after discharge.
In a prospective cohort study of inner-city adults hospitalized for acute asthma from April 1, 2001, through October 31, 2002, symptom control (Asthma Control Questionnaire) and airflow obstruction (forced expiratory volume in 1 second [FEV1] percentage predicted) were evaluated at discharge and 2 weeks after discharge. We evaluated perception of airflow obstruction (symptom control vs FEV1 percentage predicted) and perception of change in airflow obstruction (change in symptom control vs percentage change in FEV1) between the 2 visits. Acute asthma after discharge was defined as an emergency department visit or hospitalization for asthma within 90 days of discharge.
In fifty-one participants, symptom control was not significantly associated with airflow obstruction at hospital discharge (P = .30), indicating poor perception of airflow obstruction. Among the 41 participants (80.4% of those enrolled) who completed the follow-up visit, change in symptom control was not significantly associated with change in airflow obstruction (P = .20), indicating poor perception of change in airflow obstruction. Greater airflow obstruction at follow-up (P = .02) and a smaller improvement in airflow obstruction (P = .03), but not symptom control, were associated with a higher risk of acute asthma after discharge.
Patients hospitalized for acute asthma have poor perception of airflow obstruction and change in airflow obstruction. Objective measurements of lung function should guide treatment decisions after discharge in this population.
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ABSTRACT: Abstract Objective: Resistive load detection tasks enable analysis of individual differences in psychophysical outcomes. The purpose of this study was to determine both the reliability and predictors of resistive load detection in children with persistent asthma who completed multiple testing sessions. Methods: Both UNC Charlotte and Ohio University institutional review boards approved the research protocol. The detection of inspiratory resistive loads was evaluated in 75 children with asthma between 8 and 15 years of age. Each child participated in four experimental sessions that occurred approximately once every two weeks. Multivariate analyses were used to delineate predictors of task performance. Results: Reliability of resistive load detection was determined for each child, and predictors of load detection outcomes were investigated in two groups of children: those who performed reliably in all four sessions (n = 31) and those who performed reliably in three or fewer sessions (n = 44). Three factors (development, symptoms, and compliance) accounted for 66.3% of the variance among variables that predicted 38.7% of the variance in load detection outcomes (Multiple R = 0.62, p = .004) and correctly classified performance as reliable or less reliable in 80.6% of the children (x(12) = 28.88, p = .004). Conclusions: Cognitive and physical development, appraisal of symptom experiences, and adherence-related behaviors 1) account for a significant proportion of the interrelationships among variables that affect perception of airflow obstruction in children with asthma and 2) differentiate between children who perform more or less reliably in a resistive load detection task.Journal of Asthma 08/2014; DOI:10.3109/02770903.2014.955188 · 1.83 Impact Factor
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ABSTRACT: Treatment of chronic obstructive pulmonary disease (COPD) requires a personalized approach according to the clinical characteristics of the patients, the level of severity, and the response to the different therapies. Furthermore, patients with the same level of severity measured by the degree of airflow obstruction or even with multidimensional indices may have very different symptoms and limitations for daily activities. The concept of control has been extensively developed in asthma but has not been defined in COPD. Here, we propose a definition of COPD control based on the concepts of impact and stability. Impact is a cross-sectional concept that can be measured by questionnaires such as the COPD Assessment Test or the Clinical COPD Questionnaire. Alternatively, impact can be assessed by the degree of dyspnea, the use of rescue medication, the level of physical activity, and sputum color. Stability is a longitudinal concept that requires the absence of exacerbations and deterioration in the aforementioned variables or in the COPD Assessment Test or Clinical COPD Questionnaire scores. Control is defined by low impact (adjusted for severity) and stability. The concept of control in COPD can be useful in the decision making regarding an increase or decrease in medication in the stable state.International Journal of COPD 01/2014; 9:1397-405. DOI:10.2147/COPD.S71370
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ABSTRACT: Objective Accurate perception of asthma episodes increases the likelihood that they will be managed effectively. The purpose of the study was to examine the effect of feedback in a signal detection task on perception of increased airflow obstruction in children with persistent asthma.Methods The effect of feedback training on the perception of resistive loads was evaluated in 155 children with persistent asthma between 8 and 15 years of age. Each child participated in four experimental sessions that occurred approximately once every 2 weeks, an initial session followed by three training sessions. During the initial session, the threshold resistance to breathing was determined for each child. Subsequently, each child was randomly assigned to one of two resistive load training conditions in a signal detection paradigm: training with immediate performance feedback or training with no performance feedback.ResultsThe threshold resistance to breathing, determined in the initial session, was equivalent between groups. Children in the feedback condition discriminated more accurately between both the presence and the absence of increases in the resistance to breathing (206  versus 180  correct responses, p < .001), and differences over time between groups increased reliably as a function of training (165  versus 145  correct responses, p < .001). Response times and confidence ratings were equivalent between groups, and no differences in breathing patterns were observed between conditions.Conclusions Feedback training results in improved perception of respiratory sensations in children with asthma, a finding with implications for strategies of asthma self-management.Psychosomatic Medicine 09/2013; DOI:10.1097/PSY.0b013e3182a8bcde · 4.09 Impact Factor