University of Rhode Island College of Nursing, Kingston, Rhode Island.
University of Rochester School of Nursing, Rochester, New York.
Clin Exp Allergy. 2019 Mar;49(3):299-307. doi: 10.1111/cea.13250. Epub 2018 Sep 18.
Accurate symptom assessment remains challenging in teen populations. Little is known of usual symptom/response patterns, and self-reported paper diaries have traditionally low compliance rates. Therefore, we used concurrent digital voice diaries to capture daily asthma experiences.
(a) To qualitatively explore usual symptom patterns and self-management responses and (b) to quantitatively explore relationships between symptom severity and sentiment scores (a marker of emotional response to events).
Fourteen minority and nonminority teenagers (age 13-17) with controlled (50%) and uncontrolled asthma used digital recorders to report about their asthma once daily over 14 days. Dairy entries were coded for symptom frequency, severity, type, and self-management responses, while sentiment analysis was used to evaluate the emotional valence of diary entries and to explore whether increased symptom levels correlated with greater negative sentiment.
Symptom frequency and severity recorded in voice diaries were much higher than teens indicated at baseline and were discordant with clinical assessments of asthma control. Of 175 entries, teens had symptoms 69.1% of days (121/175) and severe symptoms on one-third of these. Atypical symptoms (coughing, throat clearing) were reported twice as often as traditional symptoms (wheezing, chest tightness) and often not recognized as asthma, but rather attributed to being "sick" (25.6% of symptom days). Teens frequently minimized symptoms, used rescue and controller medication inconsistently, and resorted to alternative strategies to manage symptoms. Sentiment was not significantly correlated with assessed control (β = 0.14, P = 0.28), but for teens reporting severe symptoms, sentiment scores decreased by 0.31 relative to teens without symptoms (P = 0.006).
Teens may minimize symptoms and have greater symptom frequency and severity than is recognized by themselves or providers. Screening for specific symptoms including coughing, throat clearing, and respiratory illness may be needed to identify those experiencing burden from asthma.
在青少年群体中，准确评估症状仍然具有挑战性。人们对常见症状/反应模式知之甚少，传统的纸质日记自我报告依从率通常较低。因此，我们使用同时进行的数字语音日记来记录日常哮喘经历。
(a) 定性探讨常见症状模式和自我管理反应，(b) 定量探讨症状严重程度与情绪得分（对事件的情绪反应的标志物）之间的关系。
14 名少数民族和非少数民族青少年（年龄 13-17 岁）患有控制（50%）和未控制（50%）的哮喘，使用数字记录器在 14 天内每天报告一次他们的哮喘情况。日记条目根据症状频率、严重程度、类型和自我管理反应进行编码，同时进行情绪分析以评估日记条目的情绪效价，并探讨症状水平升高是否与更大的负面情绪相关。
语音日记中记录的症状频率和严重程度远高于青少年在基线时的报告，并且与哮喘控制的临床评估不一致。在 175 条记录中，青少年有症状的天数为 69.1%（121/175），其中三分之一的症状严重。非典型症状（咳嗽、清嗓子）的报告频率是传统症状（喘息、胸闷）的两倍，而且往往不被认为是哮喘，而是归因于“生病”（占症状天数的 25.6%）。青少年经常对症状轻描淡写，使用急救和控制药物不一致，并采取替代策略来管理症状。情绪与评估控制之间没有显著相关性（β=0.14，P=0.28），但对于报告严重症状的青少年，与没有症状的青少年相比，情绪评分降低了 0.31（P=0.006）。
青少年可能会对症状轻描淡写，并且经历的症状频率和严重程度比他们自己或提供者所认识到的要高。可能需要对特定症状（包括咳嗽、清嗓子和呼吸道疾病）进行筛查，以识别那些因哮喘而感到负担的患者。
