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, and (2) differ in their perception of breathlessness. Design: Descriptive cross-sectional design. Setting and participants: The study setting was located in Northern California, an ethnically and economically diverse area. A total of 32 subjects, 16 per group, completed the study. Measurements: All had a provocation concentration of methacholine chloride causing a 30% fall in FEV1 (PC30 )o f< 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 sensation of breathlessness were present at PC30. African Americans used upper 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: deep breath (p < 0.03), lightheaded (p < 0.03), out of air (p < 0.01), aware of breathing (p < 0.03), and hurts to breathe (p < 0.06). In addition, African Americans required a significantly smaller, 44.3% (mean), dose of methacholine to achieve PC30 (p < 0.02). Conclusion: This study provides valuable new information about ethnicity and the words used to describe breathlessness during airflow obstruction. Asthmatic African Americans used primarily upper airway word descriptors; whites used lower airway or chest-wall word descriptors. Effective symptom monitoring requires asking the correct question and awareness that ethnic differences in the words used to describe breathlessness may exist. (CHEST 2000; 117:935‐943)