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Abnormal symptom perception in asthma: an overlooked problem

Published online: July 19, 2019

An unpleasant sensation of breathlessness (dyspnea) is one of the key symptoms of asthma and often triggers the use of a reliever inhaler, usually a rapid-acting β2-agonist, such as albuterol. But some patients with asthma have poor perception of symptoms and may therefore delay the use of reliever medication and be undertreated, whereas others may have increased symptom perception leading to overuse of reliever inhalers, with inappropriate use of resources and potential side effects.

In a systematic review recently published in The Journal of Allergy and Clinical Immunology (JACI), Peter Barnes and colleagues searched the published literature for studies on perception of airway function in asthma in order to better understand the factors that affect the perception of airway narrowing in asthma and to look at the consequences of under- and over-perception of asthma symptoms for the control of asthma and the use of reliever inhalers. They found 139 relevant publications to analyze.

They report that both under- and over-perception of symptoms during induced bronchospasm and bronchodilatation were common across all ages (including children) but that aging, disease severity, smoking, gender, ethnicity, psychological factors and medication were associated with differences in perception. Airway inflammation was associated with impaired perception and with a history of severe or near fatal asthma. There was little information about how perception varied over time in the same individual or how perception affected the use of reliever inhalers.

Abnormal perception of airway narrowing in asthma is common at all ages and may lead to under- or over-use of treatment, particularly inhaled reliever therapy. Perception of asthma symptoms should be assessed whenever possible, but more research on this relatively neglected topic is needed, particularly with the imminent introduction of anti-inflammatory reliever inhalers.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.