Meharry/Vanderbilt Asthma Disparities Center

Disparities in Dyspnea

Disparities in Symptom Perception and Assessment in African American Asthmatics


Principal Investigator:   Rhonda BeLue, Ph.D. (Meharry Medical College)

Co-Investigators:         William Cooper, M.D., M.P.H. (Vanderbilt)

                                    D. Scott Trochtenberg, M.D. (Meharry Medical College)

                                    James Sheller, M.D. (Vanderbilt)

                                    Dr. Ed Moore (Meharry Medical College)


African Americans suffer disproportionately from asthma and have more severe asthma and worse asthma outcomes relative to other races. Additionally, asthma hospitalization, emergency department (ED) visits and mortality among African Americans are 1.4 to 4.0 times more likely, respectively than in whites.  Several studies have identified predictors of asthma related emergency department use.  Among these predictors are, medication adherence and asthma self-efficacy. Other factors such as low income, greater asthma severity, living alone or having resided at current residence for less than one year have also been shown to predict ED usage and hospitalization in underserved asthmatic populations.  However, in this study we focus on amenable factors so that the results of this study can be used to implement future educational and clinical management interventions. Medication adherence can be defined as the patientís ability to adhere to a prescribed medication regimen. Self-efficacy can be defined as the degree of confidence that a person has that they can successfully execute behaviors to produce a certain outcome. Asthma self-efficacy can therefore be defined as oneís confidence to execute behaviors related to the management of oneís own asthma. Our overall hypothesis is that self-assessment of asthma severity, and perception of dyspnea caused by airflow obstruction, are disparately impaired in African Americans. Moreover, we hypothesize that the ability to correctly assess overall asthma severity and dyspnea relate to medication compliance and self-efficacy. Patients who are unable to correctly perceive their overall severity of asthma or perceptions of dyspnea may be unable to accurately assess the need for asthma medication. Similarly, patients may have low self-efficacy for asthma care because the discordance between perceptions of severity and dyspnea and actual asthma severity and degree of airflow obstruction may impede them from identifying the proper course of action regarding their asthma care. Therefore, we hypothesize that discordance in perceived versus actual asthma severity and airflow obstruction plays an intermediary role in disparities in Emergency Department (ED) use.

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