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Poor perception of bronchoconstriction and dynamic hyperinflation, among patients with asthma, is a risk factor for increased health services utilization

Published online: April 15, 2020

Among patients with asthma, there is a spectrum of perceptual acuity for a given degree of airflow obstruction. Some patients are poor perceivers and remain minimally symptomatic despite significant derangements in lung function. Conversely, other patients are over-perceivers and may become excessively symptomatic with relatively minor perturbations in lung function. It has long been suspected that poor symptom perception is a risk factor for life threatening asthma, but there is limited evidence in support of this.

In a recently published article in The Journal of Allergy and Clinical Immunology: In Practice, O’Loghlen et al performed high-dose methacholine challenge testing to stratify 183 patients into categories of poor-, normal-, and over-perception of bronchoconstriction and dynamic hyperinflation. The symptom perception data were linked to administrative databases at the Institute for Clinical Evaluative Sciences (ICES) to obtain objective information on health-services utilization over a 2-year period. Rates of severe asthma exacerbations (defined as emergency department visits and hospitalizations) were compared across degrees of perceptual acuity.

Poor perceivers of bronchoconstriction and, in particular, dynamic hyperinflation, were found to have higher rates of emergency department visits and admissions to hospital for asthma exacerbations. Poor perceivers of severe dynamic hyperinflation had a six-fold increased risk of severe asthma exacerbations. Identification of poor perceivers and appropriate intervention could reduce emergency health care utilization in this high-risk group of asthmatic patients.  

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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