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Vol. 44. Issue 9.
Pages 459-463 (January 2008)
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Vol. 44. Issue 9.
Pages 459-463 (January 2008)
Original Articles
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Perception of Dyspnea and Treatment Adherence in Asthmatic Patients
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Eva Martínez-Moragóna,
Corresponding author
emm01v@saludalia.com

Correspondence: Dr E. Martínez-Moragón Avda. Pérez Galdós, 12-10 46007 Valencia, Spain
, Miguel Perpiñáb, Javier Fullanaa, Vicente Maciánb, Amparo Llorisb, Amparo Bellochc
a Servicio de Neumología, Hospital de Sagunto, Sagunto, Valencia, Spain
b Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
c Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Valencia, Spain
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Objective

The majority of studies show that treatment adherence in chronic diseases such as asthma does not exceed 50%. Although the reasons may vary, it is clear that lack of treatment adherence is a determining factor in poor disease control. An association has also been observed between lack of perception of dyspnea and difficult-to-control asthma and with the occurrence of fatal or near-fatal asthma attacks. In this study we therefore attempted to demonstrate that one of the reasons that asthmatic patients do not adhere to treatment is a failure to perceive dyspnea associated with bronchial obstruction.

Patients and methods

We analyzed 2 groups of patients with moderate persistent asthma who had all been prescribed the same chronic treatment (a dose of inhaled drug administered with a dry powder inhaler every 12 hours). The first group comprised 24 patients (16 women and 8 men; mean [SD] age, 44 [15] years) who took the medication almost every day. The second group contained 24 patients (16 women and 8 men; mean [SD] age, 48 [14] years) who did not use the medication or only took it occasionally. There were no significant differences between the groups in terms of age, sex, percentage of smokers, socioeconomic and educational level, anxiety, depression, or spirometry variables. A histamine challenge test was carried out in all patients and the dyspnea perceived after each dose of the drug was measured on a modified Borg scale. The dose of histamine leading to a 20% reduction in forced expiratory volume in 1 second (FEV1), perception of dyspnea associated with a 20% reduction in FEV1 (PS20), and the change in dyspnea measured on the Borg scale between baseline and 20% reduction in FEV1 were analyzed. Patients were also classified as poor perceivers of dyspnea if the change in perception of dyspnea on the modified Borg scale was less than or equal to zero.

Results

The group of patients with poor treatment compliance had a lower PS20 (2.27 [1.9] vs 3.51 [1.8], P=.03) and change in Borg score (1.64 [1.9] vs 2.7 [1.84], P=.057), and they were more often poor perceivers of dyspnea (50% vs 21%, P=.034).

Conclusions

There is a relationship between treatment adherence and dyspnea perception, such that poor perception is among the reasons for poor treatment adherence in patients with asthma.

Key words:
Dyspnea
Asthma
Perception
Treatment adherence
Objetivo

El cumplimiento terapéutico en una enfermedad crónica como el asma no supera el 50% en la mayoría de las series. Aunque las razones sean de muy diversa índole, es evidente que el incumplimiento es un factor determinante en el mal control de la enfermedad. Por otra parte, la falta de percepción de la disnea se ha asociado con el asma de control difícil y con la aparición de crisis de asma fatal o casi fatal. Así pues, el objetivo del presente estudio ha sido intentar demostrar que una de las razones por las cuales los asmáticos no toman su medicación es que no tienen percepción de disnea cuando sus bronquios se obstruyen.

Pacientes y métodos

Hemos estudiado a 2 grupos de pacientes con asma persistente y moderada, a quienes se había prescrito el mismo tratamiento de forma continuada (una dosis de medicación inhalada en polvo seco cada 12 h). El primero estaba formado por 24 pacientes (16 mujeres y 8 varones; edad media ± desviación estándar: 44 ± 15 años) que tomaban casi todos los días la medicación, y el segundo, por otros 24 pacientes (16 mujeres y 8 varones; edad media: 48 ± 14 años) que no tomaban la medicación o lo hacían sólo de vez en cuando. No había diferencias significativas entre los grupos en cuanto a edad, sexo, porcentaje de fumadores, niveles económico y educativo, ansiedad, depresión y parámetros espirométricos. A to-dos ellos se les realizó una prueba de broncoprovocación con histamina, y se midió la disnea experimentada tras cada dosis del fármaco en una escala modificada de Borg. Se determinaron la dosis de histamina con la que se alcanzó una caída del 20% en el volumen espiratorio forzado en el primer segundo (FEV1), la percepción de disnea con una caída del FEV1 del 20% (PS20) y el cambio de disnea en la escala de Borg desde la situación inicial hasta la caída del 20% de FEV1 (cambio en Borg). Además, se clasificó a los pacientes como hipoperceptores de disnea cuando su cambio en Borg fue igual o inferior a 0.

Resultados

El grupo de incumplidores tenía menor PS20 (2,27 ± 1,9 frente a 3,51 ± 1,8 en el grupo de cumplidores; p = 0,030) y cambio en Borg (1,64 ± 1,9 frente a 2,7 ± 1,84; p = 0,057), y eran con mayor frecuencia hipoperceptores de disnea (el 50% frente al 21%; p = 0,034).

Conclusiones

Existe relación entre el cumplimiento del tratamiento y la percepción de disnea, de forma que uno de los motivos del incumplimiento terapéutico en los pacientes con asma es la hipopercepción de disnea.

Palabras clave:
Disnea
Asma
Percepción
Cumplimiento terapéutico
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This study was partially funded by grant RTIC-03/11 from the Breathe Network (Red RESPIRA) of the Carlos III Health Institute.

Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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