The Over-Under On Perception Of Asthma Symptoms
Asthma isn’t in your head, but there can be some mind games involved.
When we have asthma symptoms, our lungs physiologically get messed up—our airways become inflamed (swollen), the muscles surrounding each of the airways tighten up, and more mucus is produced. That’s the gist of it. The reality is, though, it’s your brain that really deals with those asthma symptoms coming from your lungs—known as perception.
Perception is different for everybody. Take a second to think of your grandma (aww, grandmas). You know how grandmas have this superhuman ability to wash dishes in agonizingly hot water? (And then, eventually, one day we all realize that what I can do that too and it’s not actually that hot, whether we are actually a grandma or not.) That’s because they get acclimatized to just sticking their hands in the hot water and going about their lives. Some grandmas will be able to tolerate hotter water than other grandmas, but I’d say 99% of grandmas can probably handle hotter water than I can. This is because their brains perceive the heat of that water differently—some enjoy the heat, some tolerate it, but they can all handle it without immediately jerking their hands out like I probably would. The same thing applies to asthma. And just like hot water, our reactions to our asthma symptoms are not always actually comparable with how hot the water actually is—known as incongruence.1
Perception and Asthma
Long-standing research indicates that perception of symptoms does not always correlate with how symptomatic a person with asthma actually is.2 Over-perceivers are those individuals who perceive themselves to have more severe asthma symptoms than they actually do, while under-perceivers can carry on with a significant increase in asthma symptoms without really realizing anything is wrong. Because research in this area is not extremely straightforward, an estimated 15 to 60 percent of people with asthma might be classified as under-perceivers—a statistic with a range that wide really does not mean a whole lot except that more research is needed!2
What are the risks?
Over-perceivers of asthma symptoms may use more asthma medications to treat their symptoms2,3, perhaps leading to more side-effects. Under-perceived, on the other hand, may tolerate a significant worsening of asthma symptoms which can increase chances of requiring emergency treatment or hospitalization due to inaccuracies in judging how bad their breathing actually is.3
However, it seems that over-perceivers and under-perceivers may just be wired that way.. Remember that everyone experiences dyspnea differently—researchers consider that there are four stages to symptom perception (in this research, pain tolerance): the actual feeling of dyspnea (understanding the sensation as it happens in your body), the emotional (effective) reaction to that feeling (how distressing or intolerable does it feel?), and the more long-term effects of the experience which change how we might perceive our symptoms—pain, or breathlessness suffering, and behavior (action that is taken to alleviate the symptoms).3 It is noted that the effective (emotional) component is what likely leads to seeking help or taking action to correct the symptoms.3 However, at what point we actually either notice our discomfort and/or the impact of previous experiences with dyspnea will determine our level of distress and desire for resolution of our symptoms. As symptom perception is based on your lungs, nerves, brain and emotions, it's no surprise that everyone’s asthma is so unique, and makes it slightly easier to understand why asthma is so hard to classify.
At times, I find myself in all of these categories—when I am in a fairly stable period of asthma, I am an over-perceiver. Conversely, when I’m sick, I tend to under-perceive my symptoms for whatever reason (this is often when I get reacquainted with my peak flow meter, or just taking Ventolin every 4 hours!). However, there’s no way for me to tell if I’m perceiving my symptom severity accurately, anyways—after all, it’s all “normal” for me, right?
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