"Exasperations" of asthma: A qualitative study of patients language about worsening asthma

Objectives: To identify expressions used by patients to describe worsening asthma; to examine the relevance of the word "exacerbation" to patients' experience; and to investigate whether their language is influenced by the severity of the episode and /or the target audience such as family members, friends and work colleagues. Design and setting: Qualitative study carried out from 1 January to 30 December 2004 among community volunteers to a research institute. Semistructured face-to-face interviews were used to elicit descriptions of episodes of worsening asthma, and further questioning was used to examine language used with family, employer and doctor. Participants: 25 people with asthma, aged 22-75 years. Main outcome me asure: Themes identified by open coding about patient language for worsening asthma. Results: 12 participants were not familiar with "exacerbation" and only three would use it themselves. "Attack" was the only specific term spontaneously volunteered (20 participants), but it was used for anything from mild to life-threatening episodes. Patients often downplayed the severity of worsening asthma to their families. Different language was used with employers, sometimes to justify sick leave and sometimes because of fear of perceived discrimination. When communicating with clinicians about worsening asthma, patients used symptom descriptors rather than specific terms. Conclusion: There are i mportant differences in the language patients and clinicians use to describe worsening asthma, and the word "exacerbation" has poor utility for communication with patients.