Ethnic differences: word descriptors used by African-American and white asthma patients during induced bronchoconstriction.
OBJECTIVE
To determine if African-American and white patients with asthma (1) differ in the words they use to describe their breathlessness, and (2) differ in their perception of breathlessness.


METHODS
Descriptive cross-sectional design.


METHODS
The study setting was located in Northern California, an ethnically and economically diverse area. A total of 32 subjects, 16 per group, completed the study.


METHODS
All had a provocation concentration of methacholine chloride causing a 30% fall in FEV(1) (PC(30)) of </= 8 mg/mL. Serial pulmonary function testing was performed. Breathlessness was measured using the Borg scale and the visual analog scale. Word descriptors were measured by an open-ended word descriptor questionnaire.


RESULTS
Significant ethnic differences in the words used to describe the sensation of breathlessness were present at PC(30). African Americans used upper airway word descriptors: tight throat (p < 0. 0004), scared-agitated (p < 0.006), voice tight (p < 0.04), itchy throat (p < 0.03), and tough breath (p < 0.04). Whites used lower airway or chest-wall symptom descriptors: deep breath (p < 0.03), light-headed (p < 0.03), out of air (p < 0.01), aware of breathing (p < 0.03), and hurts to breathe (p < 0.06). In addition, African Americans required a significantly smaller, 44.3% (mean), dose of methacholine to achieve PC(30) (p < 0.02).


CONCLUSIONS
This study provides valuable new information about ethnicity and the words used to describe breathlessness during airflow obstruction. Asthmatic African Americans used primarily upper airway word descriptors; whites used lower airway or chest-wall word descriptors. Effective symptom monitoring requires asking the correct question and awareness that ethnic differences in the words used to describe breathlessness may exist.
Hardie
G E
GE
University of California San Francisco, School of Nursing and Department of Medicine, San Francisco, CA, USA. ghardie@itsa.ucsf.edu
Janson
S
S
Gold
W M
WM
Carrieri-Kohlman
V
V
Boushey
H A
HA
D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000208:ethnology; D044383:Black People; D001985:Bronchial Provocation Tests; D016084:Bronchoconstriction / Q000187:drug effects; D016085:Bronchoconstrictor Agents / Q000008:administration & dosage; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007802:Language; D008297:Male; D016210:Methacholine Chloride / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D044465:White People; D001741:Black or African American
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride