PURPOSE: African-Americans (AA) have a higher rate of morbidity and mortality than Caucasians. This is a study of the nocturnal symptom barriers that may lead to a misclassifying of their severity due to descriptors of nocturnal awakening.
METHODS: In this qualitative study, focus groups of 43 AA with  asthma (separate male and female groups),  care-givers of those with asthma, and  providers of asthma care were conducted to explore the barriers to care in AA with asthma. Focus groups of AA were conducted using a standardized questionnaire and moderator. A pulmonologist was present during all focus group sessions. Focus groups were conducted until saturation of themes was obtained.
RESULTS: Although most AA reported traditional symptoms of asthma (wheezing, dyspnea and usage of rescue medications), there were variable descriptors of nocturnal symptoms. Many AA denied waking up at night due to symptoms of asthma, but would state that they used their inhalers at night or rubbed their chest. Caregivers often noted "nasal flaring" in the asthmatics at night. A frequent term used to describe nocturnal awakening in patients who otherwise denied this symptom was "the croups". Most AA who used this term characterized it as a high pitched cough, usually productive of scant sputum. Parents of asthmatic children were more likely to use this term.
CONCLUSION: This study provides insight into a communication barrier to successful asthma care in a small sample of multiple groups involved in asthma care in AA. An emerging theme is that perception and description of nocturnal symptomology is highly variable in this group.
CLINICAL IMPLICATIONS: This could lead to over-estimating the control of AA asthmatics as one of the critical evaluation symptoms of asthma control is not reported.
DISCLOSURE: David Trochtenberg, No Financial Disclosure Information; No Product/Research Disclosure Information