Ethnic differences - Word descriptors used by African-American and white asthma patients during induced bronchoconstriction

Study objectives: To determine if African-American and white patients with asthma (1) differ in the words they use to describe their breathlessness, a nd (2) differ in their perception of breathlessness. Design: Descriptive: c ross-sectional design. Setting and participants: The study setting was located in Northern Califor nia, an ethnically and economically diverse area, A total of 32 subjects, 1 6 per group, completed the study. Measurements: All had a provocation concentration of methacholine chloride causing a 30% fall in FEV1 (PC30) Of less than or equal to 8 mg/mL. Serial pulmonary function testing was performed. Breathlessness was measured using the Borg scale and the visual analog scale. Word descriptors were measured by an open-ended word descriptor questionnaire, Results: Significant ethnic differences in the words used to describe the s ensation of breathlessness were present at PC30. African Americans used upp er airway word descriptors: tight throat (p < 0.0004), scared-agitated (p < 0.006), voice tight (p < 0.04), itchy throat (p < 0.03), and tough breath (p < 0.04). Whites used lower airway or chest-wall symptom descriptors: dee p breath (p < 0.03), lightheaded (p < 0.03), out of air (p < 0.01), aware o f breathing (p < 0.03), and hurts to breathe (p < 0.06). In addition, Afric an Americans required a significantly smaller, 44.3% (mean), dose of methac holine to achieve PC30 (p < 0.02). Conclusion: This study provides valuable new information about ethnicity an d the words used to describe breathlessness during airflow obstruction. Ast hmatic African Americans used primarily upper airway word descriptors; whit es used lower airway or chest-mall word descriptors. Effective symptom moni toring requires asking the correct question and awareness that ethnic diffe rences in the words used to describe breathlessness may exist.