Asthma Clinical Trial
To investigate the determinants of valid symptom perception in childhood asthma and the relation of symptom perception to asthma morbidity.
BACKGROUND:
The treatment of childhood asthma increasingly entails self-management as an important
factor in influencing the course of the disease. The study identified subgroups of children
who were at increased risk of misinterpreting, and thus mismanaging, their pulmonary
function. Identification of the characteristics of these high risk children formed the basis
for subsequent development of an intervention program to improve symptom self-perception,
thereby enhancing the children's ability to participate effectively in self-management of
their asthma.
DESIGN NARRATIVE:
The specific hypotheses tested in the cross-sectional prevalence study were: 1) greater
validity of self-perceived symptoms was associated with less functional morbidity from
asthma; 2) specific psychological and asthma-related determinants affected the sensitivity
and specificity of symptom perception in children with asthma; 3) perception of respiratory
symptoms was a measurable characteristic that could be evaluated in terms of reliability and
validity; 4) perceptual accuracy in a natural or clinical setting was significantly related
to perceptual ability measured in a laboratory.
Investigation of these objectives used a study of validity of self-perception of symptoms in
relation to clinical status. Children aged 8-15 made subjective estimates of their asthma
severity immediately prior to pulmonary function testing at multiple times while they lived
either at a summer camp for children with asthma or a long-term asthma treatment center. The
correspondence between subjective and objective measures of pulmonary function in the
clinical environment were compared with results obtained in a laboratory using threshold
detection of added resistive loads. The sensitivity and specificity of asthmatic children's
self-assessment of symptom state were quantified and related retrospectively to risk of
functional morbidity. Cognitive abilities, anxiety level, tendency toward repression, locus
of control, and familial factors were investigated regarding their role as determinants of
sensitivity and specificity of symptom self-perception as a measure of pulmonary function.
The stability of individual patterns of self-perception were studied longitudinally with
annual repeated evaluations among those children who returned to camp or were
rehospitalized.
The study with its three-component research plan was renewed in fiscal year 1997. Component
1 strengthened understanding of the psychologic and physiologic correlates of perceptual
ability. A positive association was expected between perceptual accuracy and a)
intelligence; b) attention; c) symptom focus; d) systemic steroid use; and e) predominantly
large airway or mixed airway involvement. Component 2 explored the relationship between
chemosensitivity and resistive-load perception in high risk pediatric asthma patients. It
was hypothesized that, compared to other asthmatics and controls, adolescents who had near
fatal asthma attacks a) had higher thresholds for detecting resistive loads; b) had a
decreased response to progressive isocapneic hypoxia; and c) had a smaller increase in
respiratory drive during progressive hypercapnia. Component 3 characterized the family and
self-management patterns moderating variables between perception and morbidity. It was
hypothesized that a) symptom perception interacted with family asthma management in relation
to asthma morbidity b) poor symptom perception was associated with worse medication
compliance; and c) better family functioning was related to better perception and lower
functional morbidity. Methodologic approaches included a naturalistic clinical accuracy
protocol; laboratory studies using a computerized resistive-loading apparatus to determine
perceptual thresholds; a chemosensitivity protocol investigating drive; family assessment
interviews, and computerized metered dose inhaler technology to assess compliance with
asthma medications.
The study completion date listed in this record was obtained from the "End Date" entered in
the Protocol Registration and Results System (PRS) record.
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