Lay Experiences and Concerns with Asthma: RESULTS

Posted by James

Study findings reflect the participants’ lay conceptualizations, principal misgivings, coping strategies and basic misconceptions about asthma. These are presented here as themes: 1) deceiving nature of asthma; 2) household environment triggers; 3) lifestyle restrictions; 4) emergency department use; 5) medication use and side effects, and 6) coping strategies (Table 2). These themes are to be viewed as interrelated. A thematic narrative of the findings follows below.

Table 2. Summary of findings

Themes
1. Deceiving Nature of Asthma	4. Emergency Department Use
• Traitor	• Ineffective medications
• Demon	• Long-term hospitalizations
• Temporary	• Lack of health insurance
• Deceiving	5. Medication Use and Side Effects
• Unpredictable	• Side effects of medications
• Deadly	• Cold medicine for coughing
2. Household Environment Triggers	• Machine use to decongest lungs
• Heaters	6. Coping Strategies
• Dust	• New activities
• House cleaning products	• Avoid taking medicine
• Pets	• Alternatives to medicine
• Tobacco smoke	• Sleep upright
3. Lifestyle Restrictions/Adaptations	• Control indoor triggers if possible
• Sleep deprivation
• Missed school days
• Limitations in physical activities

Narrative of Findings

1. Deceiving nature of asthma. Participants clearly held a deceiving and deeply worrisome perception about asthma. For example, a mother of two teenage girls with asthma described how one of them “… gave me most problems since she was born … her asthma is very deceiving … she could be fine and all of the sudden get asthma …” In this same case, the mother describes her daughter’s asthma as ephemeral: “… she doesn’t get it like others do … her asthma is temporary, she doesn’t get it after coughing or with a fever, no, it hits her suddenly.” Asthma was perceived by some as “deadly:” “.. .you get worried because it’s deadly … you’re watching someone having an attack and rushing them to the ER … seeing people all over the person you love …” Others personified asthma as a “traitor” or “demon.” As one respondent described, “… I call it my enemy … the demon that comes after [me] … When I’m in the middle of something good, this little devil comes out of nowhere and attacks me … I can’t stand it.”

2.  Household environment triggers. Above all, participants were specific about a variety of indoor household allergens compared with outdoor ones, particularly as residents spend more time inside their homes during the cold winter season. Allergens that participants were more aware of and concerned about included: heaters, pets, dust, house cleaning products and tobacco smoke. For example, one respondent noted that her “… mother’s heater is constantly 100° and she used to dress up with lots of clothes … she needs some fresh air…three times in two months she would go to the hospital with asthma.” Another one stated: “… when I get around bleach … it’s over with. It just hurts … strong cleaners … I can’t get near …” Others cited: “the rugs in the house accumulate the dust and that affects you.” Also, “… whenever I get a chest cold or am around cigarette smoke …” in the house were mentioned as common triggers.

3.  Lifestyle restrictions and adaptations. Quality of life was central to all the workshop participants. Loss of sleep for both children and parents appeared to have significant impact on their quality of life. As one parent put it, “… at night … you can never get enough sleep because you worry that something is going to happen [to the child] if you’re not there.” Another one complained, “[the child] will sleep at night, but I have to be up every four hours making sure he’s breathing alright … I’m the one who’s up all night.” Participants were also very concerned about the interference of asthma on their children’s school attendance and school performance. One mentioned that”… my little boy gets sick all the time … sometimes misses two or three days in a row, and I have to send him sick to school to avoid problems … about absences … though I’ve informed the school about my son’s [asthma].” Parents were concerned that school staff would not recognize when their child required medical attention. Several participants described the limiting effect of their asthma on singing, exercise and outings. Most were particularly concerned with the unknown threats and uncertainties of asthma that could further limit their way of life. Medication you can afford finasteride 5 mg

4.  Emergency department use. Participants recounted several instances when they had to run to the emergency department or be hospitalized because of their asthma. For example, they were concerned about the perceived inevitability of emergency department visits, particularly when medications prove ineffective. According to one parent “… sometimes the asthma machine at home and other medicines didn’t help her [daughter] … we had to take her to the hospital …” Another one reported,
“… we ended up going to the ER three times … sometimes it gets out of control…the pump doesn’t work when you’re having a severe asthma attack and you need steroids.” Lack of health insurance was also a concern for others who felt compelled to defer medical treatment. When probed for why most end up in the emergency department, one respondent also noted: “… for insurance reasons, you don’t have any medication at home.”

5. Medication use and side effects. The topic of asthma treatments also raised some important issues besides their perceived role in hospital visits. Participants were concerned about the side effects of some medications, including vomiting, coated throat and hyperactivity, among others. Some participants were frustrated and confused by similarities between asthma symptoms and those of other illnesses. Some used cough syrup to treat a cold before learning that they should “not give her [child] cough or cold suppressant or anything like that, just to let the cold come out on its own …” Furthermore, some participants believed that the “machine” (nebulizer) is for cleaning and decongesting the lungs. Some reiterated that occasionally asthma medications were not efficacious, sometimes resulting in an emergency department visit. discount singulair

6. Coping strategies. Participants shared some of the strategies they used to cope with limitations caused by their asthma. Participants felt that they could at least try to control household triggers, as many were frustrated by their perceived lack of control, for example, over others who smoke outside the home. Restrictions on lifestyle patterns were a major concern and often resulted in straying from management strategies. Some creatively adjusted their lifestyle to engage in new activities related to what they love to do. For example, one participant discussed her child’s limited physical activity due to asthma but found that swimming helped and, thus, kept her child engaged in such activity instead of in running. Some respondents avoided taking prescribed medications because of the side effects and instead “waited out” an asthma episode or performed deep-breathing exercises. Participants also shared sleeping patterns that made it easier for them to breathe. As one respondent stated, “when I sleep on my back, I feel like my lungs are deflated … If I sleep on my side … my arm is pressing down and I cannot breathe, so I always have to sleep with three pillows …”