Skip to Accessibility Tools Skip to Content Skip to Footer
The over-under on perception of asthma symptoms.

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?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Inaccurate perception of asthma symptoms: a cognitive-affective framework and implications for asthma treatment. Clinical psychology review. Accessed February 27, 2017.
  2. Cukier A. Perception of asthma symptoms. Jornal Brasileiro de Pneumologia. Accessed February 27, 2017.
  3. American Journal of Respiratory and Critical Care Medicine. American Journal of Respiratory and Critical Care Medicine. Accessed February 27, 2017.


  • jcmusiclover
    4 months ago

    Interesting this would be today’s post. My doc told me I had to stop trying to “push thru” because it wasn’t helping and I had gotten myself a bit further into trouble requiring much higher doses of steroids. Sadly, I had to give in and home to sofa surf instead of going to work.

  • John Bottrell, RRT moderator
    4 months ago

    That is pretty interesting. If it makes you feel any better you’re not alone in “pushing through” asthma episodes. Hope you feel better soon. John. Site Moderator.

  • Leon Lebowitz, RRT moderator
    4 months ago

    Hi jcmusiclover and thanks for your post. As John mentioned, you are certainly not alone in this community. You may find this is very personal – sometimes you can manage the condition successfully with the treatment plan you have on hand. Other times, additional intervention may be needed. It can vary from patient to patient. It can also vary for the same person depending on the particular episode. This time, you wound up on the couch. The next time you may be able to get past it on your own. Feel better! Leon (site moderator)

  • Poll