However, inaccurate perception of asthma symptoms can be conceived as dependent on two major groups of overarching psychological variables: expectancy-related and affective variables. Because the P1 peak is thought to Which variables modulate symptom perception accuracy?Ī wide variety of psychological variables that influence symptom perception in general (Pennebaker, 1982), and respiratory symptom perception in particular (De Peuter et al., 2004, Von Leupoldt and Dahme, 2007) have been listed. A specific P1 peak was only observed in about half of the patients with LTA in reaction to inspiratory occlusion, whereas almost all control subjects showed a P1 peak. Using respiratory related evoked potentials (RREP), Davenport, Cruz, Stecenko, and Kifle (2000) identified patients with a stable perceptual deficit in a sample of children with a history of life-threatening asthma (LTA). Obviously, a small group of asthma patients are stable underperceivers. Comparing symptoms and lung function has yielded both categorical approaches to poor perception, classifying patients not responding with symptoms to induced Is over- or underperception of asthma symptoms a dispositional variable? This may be naturally occurring bronchoconstriction, or may be induced, for example, in a provocation test or by breathing against an external respiratory resistance. Section snippets Assessment of accuracy of symptom perception in asthmaĪ first group of methods assessing the accuracy of symptom perception is based upon a comparison of an objective index for obstructed breathing with self-reported symptoms. Since there is no standard method of assessing symptom perception, we will first briefly discuss the various methods that can be used to assess accuracy of symptom perception in asthma. We will challenge this assumption and advance evidence to claim that (a) apart from a small group of patients with a perceptual deficit, asthma patients with poor symptom perception are not consistent in their under- or overperception, (b) poor symptom perception is largely influenced by expectation and emotional factors, interacting with personality and situational context, and (c) interventions changing affect-related variables can play an important role in the treatment of a substantial subset of asthma patients. An implicit assumption underlying this distinction is that under- and overperception of asthma is a stable, one-dimensional trait-like characteristic, analogous to near- and farsightedness in visual perception. The group of poor perceivers is further divided into two distinct subtypes, namely under- and overperceivers (Ciccone et al., 2007, Magadle et al., 2002, Teeter and Bleecker, 1998, Yoos et al., 2003). Poor symptom perception is considered an important factor in asthma morbidity, but the estimated prevalence varies widely, ranging from 15 to 60% of asthma patients, depending on the measurement used (Kendrick et al., 1993, Magadle et al., 2002, Rubinfeld and Pain, 1976, Teeter and Bleecker, 1998). Since the 1970s, a low congruence between symptom reports and pulmonary function measures has been reported in asthma patients using a variety of methods (Boulet et al., 1994, Kendrick et al., 1993, Magadle et al., 2002, Rubinfeld and Pain, 1976, Teeter and Bleecker, 1998). The model can act as a framework to understand both normal perception as well as under- and overperception of asthma symptoms and can guide the development of affect-related interventions to improve perceptual accuracy, asthma control and quality of life in asthma patients. Based on these findings and incorporating recent work on associative learning, attention and mental representations in anxiety and symptom perception, we propose a cognitive–affective model of symptom perception in asthma. Particularly, expectancy and affective cues appear to have a powerful influence on symptom accuracy. We argue that little evidence exists for a trait-like stability of under- and overperception and that accuracy of respiratory symptom perception is highly variable within persons and strongly influenced by contextual information. In this paper we point out that this division is problematic. Typically, patients who inaccurately perceive asthma symptoms are divided into underperceivers and overperceivers. Inaccurate perception of respiratory symptoms is often found in asthma patients.
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