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Learning Objective 1: Understand the experience of adolescents with uncontrolled asthma including symptoms, feelings, activities and medication use through the analysis of a 24-hour asthma diary.
Learning Objective 2: Evaluate the validity of the information in the asthma diary through audio-recording of asthma symptoms and medical records review.
Methods: Twenty-nine adolescents (13-17 years; mean=14.6) with current uncontrolled asthma were recruited from the Emergency Department (n=19; 66%), and pediatric practices (n=10; 34%). The subjects provided a 24-hour asthma diary and audio-recording of symptoms using a digital audio-recorder. Electronic medical records were reviewed at the time of study enrollment for prescribed asthma medications.
Results: Females accounted for 55% (n=16), and the majority (66%) were from non-White background. Coughing was the most common symptom (96%) followed by wheezing (79%) and shortness of breath (72%). Chest/back pain and chest tightness were reported by 28% and 24%, respectively. Self-reported coughing and wheezing were consistent with the audio-recorded symptoms in 93% (n=27). Participants reported a wide range of negative feelings: tired, uncomfortable, irritated, panicked, scared, afraid and sad. Activities were rated on a 4-point scale (1being sedentary and 4 being intense), and most (n=21, 72%) reported the activity level at 2 or below. Discrepancies in medications between self-report and medical records were found in all participants (n=27) whose records were available electronically. Common inconsistencies in medications were: anticholinergics (83%), leukotriene antagonists (73%), inhaled corticosteroids (64%) and oral steroids (42%). Primarily, the inconsistencies were due to participants’ under-report of their medications.
Conclusion: An asthma diary is a valuable tool for adolescents with uncontrolled asthma to monitor symptoms, feelings and activity. While self-report symptoms in the diary are highly valid, adolescents tend to underreport medications, suggesting questionable adherence to prescribed medications. Preponderances of negative feelings and low activity levels may indicate poor quality of life and call for appropriate interventions.
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