Feature Article

Patients May Not Understand Asthma Terminology as Well as Physicians Think
16(1):1, 15.

“Asthma exacerbation” is a term commonly used by physicians when talking to their asthma patients. However, it is likely that most patients do not know the meaning of that phrase, according to survey results.


VANCOUVER—Many physicians may agree that an asthma attack or an asthma flare-up is the same event as an asthma exacerbation; however, patients may not be familiar with the phrase “asthma exacerbation,” according to survey results presented at Chest 2010.

Terms used among medical professionals and in the peer review literature may not be used colloquially, the researchers said, and “effective communication between patients and their physicians can only occur when the vocabulary used conveys the same meaning to both parties.”

Telephone Survey of Patients and Physicians
Robert A. Nathan, MD, from the Asthma and Allergy Associates, PC and Research Center, Colorado Springs, Colorado, and colleagues screened 60,682 households via a nationwide computer-assisted, random-digit dialing telephone search. Of those screened, 2,500 patients with current asthma ages 12 and older completed the telephone survey. Current asthma was defined as diagnosis or exacerbation within the past year, or taking asthma medication at the time of the survey. For patients who were younger than 18, the adult in the household most knowledgeable about that patient’s asthma and its treatment was interviewed.

Of 3,605 physicians randomly selected from the American Medical Association/American Osteopathic Association master list, 101 family practitioners, 104 allergists, 54 pulmonologists, and 50 internists completed the telephone interview.

Questions asked of patients:

  • Have you ever heard of the term “asthma flare-up?” “Asthma exacerbation?” “Asthma attack?”Would you say asthma flare-ups and exacerbations are the same thing? (Only asked of patients who had heard of both terms.)
  • Is an asthma attack the same thing as an asthma flare-up or exacerbation? (Only asked of those who had heard of the term “asthma attack.”)
  • Would you consider “asthma symptoms worsening” the same thing as an “asthma flare-up?” (Only asked of those who had heard of the term “asthma flare-up.”) “Asthma exacerbation?” (Only asked of those who had heard of an exacerbation.) “Asthma attack?” (Only asked of those who had heard of an exacerbation.)

Physicians were asked the following questions:

  • Do you normally use the following terms (ie, “asthma flare-up,” “asthma exacerbation,” “asthma attack”) when discussing asthma with your patients?
  • Would you say asthma flare-ups and exacerbations are essentially the same thing?
  • Is an asthma attack the same thing as an asthma flare-up or an asthma exacerbation?
  • Would you consider “asthma symptom worsening” the same thing as an “asthma flare-up,” “asthma exacerbation,” or “asthma attack?”

Differences in Understanding
From 57% of pulmonologists to 78% of allergists (70% of physicians overall) reported using the term “asthma flare-up” when talking to their patients. Most patients (71%) reported having heard of this term.

However, while only 24% of patients had heard of the term “asthma exacerbation,” 77% of physicians overall reported using the term—including 69% of family practitioners, 76% of allergists, 93% of pulmonologists, and 78% of internists.

Of the three terms, “asthma attack” was used least frequently by physicians—specifically, by 71% of family practitioners, 58% of allergists, 57% of pulmonologists, and 74% of internists (65% of physicians overall). By contrast, nearly all patients (97%) reported having heard of this term.

Almost all physicians reported that they considered “asthma flare-up” and “asthma exacerbation” to mean essentially the same thing, compared with only 38% of patients who had heard both terms.

Between 56% and 74% of physicians considered an asthma attack to the be the same as an asthma flare-up or asthma exacerbation, while 36% of patients who had heard of the term “asthma attack” considered it to be similar to an asthma flair up or exacerbation.

“More than half of physicians equated ‘asthma symptoms worsening’ with ‘asthma exacerbation’ … and ‘asthma flare-up’ but less than half of physicians and patients equated ‘asthma symptoms worsening’ with ‘asthma attack.’” Nearly a quarter of physicians did not consider asthma symptoms worsening to be the same as an asthma flare-up, exacerbation, or attack.

These study results show that there is “a substantial communication gap” between doctors and patients, the investigators concluded.

“A commonly understood terminology is needed for physicians to effectively explain the meaning of asthma exacerbations and help their patients understand what can be done to prevent them,” they added.

—Adriene Marshall


Suggested Reading
Fuhlbrigge AL, Adams RJ, Guilbert TW, et al. The burden of asthma in the United States: level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines. Am J Respir Crit Care Med. 2002;166(8):1044-1049.

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