The Adaptive Effect of Illness-Specific Panic-Fear on Asthma Outcomes in Mexican and Puerto Rican Children

To assess how illness-specific panic-fear is associated with asthma outcomes over a year period.

The study population consisted of 267 Latino patients from age 5–12 years who were recruited from asthma/allergy clinics at 2 inner-city hospitals in the Bronx, New York (n = 110) and 2 school-based health clinics in Phoenix, Arizona, and Phoenix Children’s Hospital Breathmobile (n = 157) between June 2010 and October 2013.

A number of measures were taken to assess the patients’ asthma symptoms and control. The participants completed the Childhood Asthma Symptom Checklist (CASCL) which assesses illness-specific panic-fear, and then their caregivers completed a parent version of the CASCL and a number of other scales to assess social and contextual factors. Furthermore, patients did pulmonary function tests (PFT) and Asthma Control Tests with their visits every 3 months. Acute health care utilization was assessed by caregiver reports and medical chart review with each visit. Finally, adherence monitoring was assessed with patients on inhaled corticosteroid with the use of the Doser device that tracks the use of the inhaler.

Of the 267 Latino patients enrolled, 82% completed 3 or more of the 5 assessments over the 12-month period. The Arizona sites consisted almost entirely of Mexican families (99.4%) and the New York site consisted of 70.9% of Puerto Rican families. The child self-report of illness-specific panic-fear predicted higher FEV₁ in Mexican children and predicted better asthma control on ACT in Puerto Rican children. Furthermore, child’s panic-fear predicted lower healthcare utilization for acute asthma-related issues in both Puerto Rican and Mexican children. The caregiver report of child’s panic-fear predicted higher FEV₁ in both groups of patients.

Child self-report of illness-specific panic-fear rather than overall general anxiety was a good predictor of multiple asthma outcomes, including increased FEV₁, asthma control on ACT, and healthcare utilization whereas the parent’s report of a child’s panic-fear predicted increased FEV₁ only. This illness-specific panic-fear suggests that a child’s ability to appreciate their anxiety during an asthma attack is associated with heightened vigilance and subsequent improved management of asthma long-term and in acute attacks.

Previous research has noted health disparities in ethnic minorities with asthma. Importantly, this study focused on determining in one minority group whether disease specific panic-fear, not general anxiety, could lead to better outcomes in asthma. The authors report that a child’s specific anxiety around their asthma may lead to improved asthma control and possibly more rapid treatment during attacks. This suggests that assessing a child’s anxiety should be an important behavior parameter to assess for the child to better understand their disease and lead to subsequent improvement in asthma control and treatment.