Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis

Abstract

Background: Under-perception of pulmonary dysfunction may delay appropriate treatment, while over-perception may result in unnecessary treatments. Objectives: To evaluate the ability of patients with asthma or cystic fibrosis and their subspecialty caregivers to assess changes in lung function based on their subjective clinical impressions. Methods: Patients were asked to qualitatively describe how they felt compared to their prior visit (same/better/ worse) and to quantitatively estimate their forced expiratory volume in 1 s (FEV 1) after being reminded of their FEV 1 at the prior visit. Providers made similar estimates based on history and physical examination and knowledge of prior FEV 1. After adjusting for relevant clinical covariates, lung function estimates were categorized as accurate (-5% of measured FEV 1), overestimated (>5% above measured), and underestimated (>5% below measured). Results: One hundred nine patients estimated FEV 1 on 179 occasions. Concordance between patient qualitative assessment and FEV 1-based categories was low (j = 0.08); 44% of patients reported feeling better than the FEV 1based category showed. Quantitatively, 56% of patient estimates were accurate, 18% were underestimated, and 26% overestimated; accuracy improved with age (odds ratio = 1.16, P = 0.01). Concordance between provider qualitative assessments and FEV 1-based category was moderate (j = 0.35); about 19% said their patient looked better than the FEV 1-based category showed. Quantitatively, 65% of provider estimates were accurate, 16% were underestimated, and 19% were overestimated; accuracy improved with years of experience. Conclusions: Patients' and providers' perceptions of lung function were low to moderately accurate. Relying on subjective impression may place patients at risk for unnecessary treatments or increased morbidity. These findings highlight the importance of objective lung function assessment.

Technical validity and usability of a novel smartphone‐connected spirometry device for pediatric patients with asthma and cystic fibrosis

“…Longitudinal data on a regular basis regarding pulmonary health could be very valuable for patients, clinicians, and clinical researchers, and this could be obtained by performing PFTs at the patients' home. An increase in readily available objective longitudinal data could be particularly useful in pediatrics, as children often find it difficult to perceive and express the severity of their symptoms 2,3 …”

Symptoms and perception of airway obstruction in asthmatic patients: Clinical implications for use of reliever medications

“…Poor perception of airflow limitation might lead to a delay in starting appropriate treatment or inadequate use of treatment that has already been prescribed, potentially increasing the risk of an asthma exacerbation or even death from asthma. 9,26,27,48 This is particularly important given the association between impaired perception and airway inflammation 13,32,43 because the very patients who are at greatest risk of life-threatening exacerbations might be least able to identify that their asthma is worsening. However, it is reassuring that in a longitudinal study mean perception improved after initiation of ICS treatment.…”

“…Overperception of relatively minor airways obstruction or bronchoconstriction might result in overuse of medication, 9,27,48 with the risk of iatrogenic adverse effects and potentially avoidable visits to health care practitioners or hospital emergency departments. 9 Therefore there is a need for further research into the effect of underperception and overperception of bronchoconstriction or bronchodilatation on an individual patient's use of reliever and controller inhalers.…”

“…A study of 179 children aged 6 to 17 years (mean, 12.0 years) with cystic fibrosis (n 5 107) or asthma (n 5 72) found that selfassessed quantitative estimates of airway obstruction by asthmatic patients matched their FEV 1 values in 56% of cases, with 18% underestimating and 26% overestimating them. 27 More than 44% of patients said that they felt better than their FEV 1 measurements indicated they should (eg, they felt ''better'' when FEV 1 was the same/worse). Both qualitative and quantitative accuracy were greater with greater age (odds ratios, 1.14 and 1.16 [P 5 .03 and P 5 .01], respectively).…”

“…Both qualitative and quantitative accuracy were greater with greater age (odds ratios, 1.14 and 1.16 [P 5 .03 and P 5 .01], respectively). 27 Ethnicity Only 1 study assessed the effect of ethnicity on perception of airway obstruction. Changes from baseline in Borg scores in response to a methacholine-induced 30% decrease in FEV 1 (PC 30 ) were lower for Asian-Pacific Islanders (n 5 18, P < .03) than for African Americans (n 5 24), Hispanic-Mexican Americans (n 5 14), and white patients (n 5 34).…”