Beware of Dog: Practical Consideration in Asthmatic Patients with Poor Perception of Respiratory Symptoms

Symptoms are often difficult to quantify, represent and depict for the patients and sometime also for the attending physicians. Anyway their role is crucial in influencing the relationship patient/physician in many ways. Respiratory symptoms (cough, thoracic pain, dispnoea) are not free of this challenging drawback. In asthmatic patients the subjective awareness of their disease condition, expecially their insight in the quality of breathing pattern, is critical to assess severity and control of their disease: under-perception of respiratory symptoms make this task problematic for patients and physicians. To estimate the magnitude of problem two set of reports have been examined: one on “real life” patients with chronic stable asthma and secondly studies evaluating the level of perception in selected asthmatic patients in a laboratory setting using bronchial provocation tests tool. Cumulatively a rough percentage of 20% asthmatic patients showed a reduced ability to be aware of their low level of pulmonary function. This impaired ability to perceive and report symptoms could also be a harbinger of undesirable and sometimes dangerous consequences. These data show that poor perception in asthma is a challenging problem affecting a large proportion of patients, with the potential of severe outcomes that need to be accurately addressed.