Current perspectives on symptom perception in asthma: A biomedical and psychological review

Symptom perception in patients with asthma is often inadequate. Patients ma y fail to perceive serious airway obstruction or suffer from breathlessness without objective cause. These extremes are associated with fatal asthma a nd excessive use of medicines, respectively. This article covers symptom pe rception in a multidisciplinary perspective. A presentation of current defi nitions and methods for studying symptom perception in asthma is followed b y a summary of theories on the origin of breathlessness. Next, biomedical a nd psychological factors influencing symptom perception are examined. Preli minary biomedical research emphasizes neural pathway impairment, but causal factors remain inconclusive, particularly regarding the overperception of symptoms. Psychological studies suggest that the accuracy of symptom percep tion is influenced by (a) competition between asthmatic and nonasthmatic se nsory information, (b) negative emotions, and (c) acquired response tendenc ies (e.g. habituation to symptoms, repression of symptoms, selective percep tion, and false interpretation of symptoms). These factors may favor either blunted perception or overperception. Empirical data in support of psychol ogical factors are still insufficient. Methodological problems and procedur es to improve symptom perception are discussed.