No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma.
OBJECTIVE
Asthma morbidity and mortality is highest among inner-city populations. Suboptimal beliefs about the chronicity of asthma may perpetuate poor asthma control among inner-city asthmatics. This study sought to characterize beliefs about the chronicity of disease and its correlates in a cohort of inner-city adults with persistent asthma.


METHODS
Prospective, longitudinal, observational cohort study.


METHODS
One hundred ninety-eight adults hospitalized with asthma over a 12-month period at an inner-city teaching hospital.


METHODS
Sociodemographics, clinical history, disease beliefs, and self-management behaviors were collected by interview. Information on self-reported use of inhaled corticosteroids (ICS), peak flowmeters, and regular asthma visits was collected during hospitalization, and 1 month and 6 months after discharge.


RESULTS
This cohort was predominantly low income and nonwhite, with high rates of prior intubation, oral steroid use, and emergency department visits and hospitalizations. Overall, 53% of patients believed they only had asthma when they were having symptoms, what we call the no symptoms, no asthma belief. Men patients, those > or = 65 years old, and those with no usual place of care had greater odds of having the no symptoms, no asthma belief, and those receiving oral steroids all or most of the time or with symptoms most days had half the odds of having this belief (p < 0.05 for all). The no symptoms, no asthma belief was negatively associated with beliefs about always having asthma, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. The acute disease belief was associated with one-third lower odds of adherence to ICS when asymptomatic at all three time periods (p < 0.02 for all).


CONCLUSIONS
The single question, "Do you think you have asthma all of the time, or only when you are having symptoms?" can efficiently identify patients who do not think about or manage their asthma as a chronic disease.
Division of General Internal Medicine, Mount Sinai School of Medicine, Box 1087, One Gustave L. Levy Place, New York, NY 10029, USA. ethan.halm@mountsinai.org
Ethan A
EA
Halm
Pablo
P
Mora
Howard
H
Leventhal
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000517:prevention & control*; D002908:Chronic Disease; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D011446:Prospective Studies; D012648:Self Care; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*