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No Symptoms, No Asthma^*

The Acute Episodic Disease Belief Is Associated With Poor Self-Management Among Inner-City Adults With Persistent Asthma

^* From the Division of General Internal Medicine (Dr. Halm), Department of Medicine, Mount Sinai School of Medicine, New York, NY; and Institute for Health, Health Care Policy and Aging Research (Drs. Mora and Leventhal), Rutgers University, New Brunswick, NJ.

Correspondence to: Ethan A. Halm, MD, MPH, Division of General Internal Medicine, Mount Sinai School of Medicine, Box 1087, One Gustave L. Levy Place, New York, NY 10029; e-mail: ethan.halm{at}mountsinai.org

Abstract

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.

Design: Prospective, longitudinal, observational cohort study.

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

Measurements: 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 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).

Conclusion: 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.

Key Words: adherence • asthma • behaviors • beliefs • knowledge

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