Illness Perceptions and Panic-Fear in Coping with Difficult Asthma

Difficult Asthma is a complex diagnosis relating to poor asthma control, but less related to severe clinical pathology. It is associated with medication non-adherence, poor psychosocial outcomes and high usage of health services. A number of psychological variables have been linked with the diagnosis. The systematic review examined the qualitative literature concerning patients’ experiences of self-managing asthma. A meta-ethnographic approach was used in order to add a layer of interpretive synthesis to the reciprocal translation of studies. A number of overarching themes were identified; Establishing Normality explored patients’ striving to achieve a balance between asthma symptoms, medication and quality of life. Beliefs about Medication identified common distrust of conventional medicine and the strategies used to find alternative ways to cope. Therapeutic Relationship gave voice to the frustrations of patients at being expected to self-manage asthma in a context of poor communication, unidirectional consultations and lack of access to quality information. Lack of policy implementation concerning shared models of care are considered. The empirical study extended the theme of patients managing asthma according to subjective beliefs. The self regulation model was used as a framework to understand the illness perceptions of adults attending a Difficult Asthma Clinic. The intention was to move discussion towards an understanding of illness perceptions as clusters or schemata of beliefs rather than individual dimensions. Four distinct clusters were established in this population based on their illness perceptions; these groups significantly varied on experiences of panic during asthma attacks and the strategies they used to cope with asthma, as well as clinical features such as age at diagnosis. Lung function did not differ between groups, suggesting there may be several potential routes to Difficult Asthma. The potential for tailored psychological interventions, care pathways and future research are discussed within a framework of mutual responsibility for disease management.