GE Hardie, UCSF, School of Nursing; S Janson, UCSF, School of Nursing; HA Boushey, UCSF, School of Medicine; VC Carrieri-Kohlman, UCSF, School of Medicine; WM Gold, UCSF, School of Medicine

Objectives: Inadequate symptom control with inappropriate treatment may contribute to the present increase in asthma morbidity and mortality in African Americans. The words that African Americans use to describe their breathlessness have not been previously studied. The purpose of this study was to ascertain the differences in the perception of breathlessness between African American and Caucasian asthmatics during induced bronchoconstriction.

Methods: We studied 32, 16 per group, African American and Caucasian asthmatics (mean age 34.5 yrs). All had mild asthma (mean forced expiratory volume in 1 second [FEV1] 97.5% predicted and controlled only with intermittent beta agonist. No inhaled steroids or other meds; all were atopic and non-smokers. All had a methacholine (Mch) challenge causing a 30% fall in FEV1 (PC30) to < 8 mg/ml. Breathlessness was measured by the Borg and VAS scale; word descriptors were measured by an open ended word descriptor questionnaire.

Results: African Americans used upper airway word descriptors: "tight throat" (p<.004), "voice tight" (p,.04), "itchy throat (p<.03), "tough breath" (p<.04), "scared-agitated" (p<.006). Caucasians used chest symptom descriptors: "deep breath" (p<.03), "out of air" (p<.01), "hurts to breathe" (p<.06), "aware of breathing" (p<.03), "lightheaded" (p<.03). Breathlessness scores (Borg and VAS) were not different at PC30. African Americans required a significantly smaller dose of Mch to achieve the same degree of bronchconstriction (p<.02). Baseline FEV1 did not differ.

Conclusions: African Americans with asthma use different words than Caucasians to describe their respiratory sensations during airflow obstruction. In addition, African Americans required a significantly smaller dose of Mch to induce the same degree of bronchoconstriction.

Impact: As clinicans we need to be aware that for some African Americans upper airway symptoms may reflect acute airflow obstruction. At the same time, it is imperative to educate other health professionals about the differences in the language of breathlessness since it is possible that undertreatment of asthma symptoms for African Americans may occur.