Symptom Perception

Asthma is a common condition in the older population and associated with worse morbidity and
mortality compared to younger individuals. Various self-management behaviors (SMB),
medication adherence in particular, are key for achieving good asthma control. Unfortunately,
less than half of older asthmatics regularly adhere to their controller medications and to
other SMB. Several observations suggest that symptom perception may be a major determinant of
asthma SMB and outcomes in older adults. First, experimental studies consistently demonstrate
that many older adults are substantially less aware of their level of airway obstruction.
Second, under-perception of asthma symptoms is linked to elevated risk of near-fatal and
fatal asthma attacks and increased morbidity among younger adults. Third, cognitive
impairment, commonly associated with aging, has been identified as a key determinant of
under-perception of symptoms in younger asthmatics. Fourth, interventions to correct symptom
under-perception in children have been shown to improve asthma medication adherence. Despite
the greater vulnerability of older asthmatics to poor asthma outcomes and their diminished
ability to perceive the severity of their airway obstruction, the association of symptom
perception with asthma SMB and outcomes has not been studied in this population. The goal of
this project is to determine how symptom perception influences the management and outcomes of
older asthmatics and to pilot test an intervention to correct under-perception. The Specific
Aims are: 1) Prospectively assess the association between symptom perception and asthma
morbidity among older adults; 2) Examine the association between symptom perception and
asthma SMB among older adults and identify the pathways (via illness and medication beliefs)
linking them; 3) Determine the influence of cognition on symptom perception among older
adults with asthma; 4) Pilot test an intervention to correct under-perceptions of asthma
symptoms in older adults. The investigators will conduct a prospective cohort study of 400
asthmatics ≥60 years of age recruited from East Harlem and the Bronx in New York City. The
investigators will measure symptom perception in naturalistic settings using an innovative
and validated methodology and repeatedly collect data on illness and medication beliefs,
cognitive functioning, SMB (including objective measures of medication adherence), and asthma
morbidity over 12 months. At the end of the observation period, the investigators will pilot
test an intervention to improve symptom perception on a random sample of 80 participants. The
proposed study is significant for its potential to greatly advance understanding of the
mechanisms related to low adherence to SMB and worse outcomes in older asthmatics, a
vulnerable and understudied population.

Inclusion Criteria:

- Age ≥60 years

- English or Spanish speaking

- Asthma diagnosis made by a health care provider

Exclusion Criteria:

- Diagnosis of dementia

- Diagnosis of chronic obstructive pulmonary disease (COPD) or other chronic respiratory
illness

- Smoking history of ≥15 pack-years owing to possible undiagnosed COPD

- Moderate or severe cardiac disease (including New York Heart Association stages 4 or 5
congestive heart failure, because dyspnea among patients with severe heart failure is
more likely to be attributable to their heart condition than their asthma)

- Dependence on assistance for medication administration

- Uncorrectable visual impairment