Asthma

Language matters: why the term ‘exacerbation’ should be dropped


Clinicians should avoid the term asthma ‘exacerbation’ because it confuses and misleads patients who think it means a slight deterioration in lung function or modest increase in symptoms, an Australian study has found.

Asthma ‘attack’ should be the preferred language when communicating with patients because this is the term most use to describe the serious and often life-threatening symptoms and deterioration in lung function, according to a survey of Australians with severe asthma.

Feedback from a panel of 18 patients with severe asthma and 10 with mild-moderate asthma from Australia and the UK supported the recommendations of a 2017 Lancet Commission on Asthma that called for a change in language to use ‘attack’ because this implies urgency in immediate action and zero tolerance for a future event.

In a series of interviews with people with severe asthma, researchers at the Hunter Medical Research Institute, Newcastle University, found that all used the term asthma ‘attack’ spontaneously and only two used both ‘exacerbation’ and ‘attack’.

The term ‘flare-up’ was used infrequently and to refer to both severe and mild asthma-related events.

When asked what they perceived by the terms, patients said an ‘asthma attack’ meant a serious, life threatening event, in which their asthma was out of control, the ‘worst’, and they were unable to breathe.

In contrast, the terms ‘exacerbations’ and ‘flare-ups’ were perceived to mean gradual, less severe increases in symptoms, which they described in terms such as ‘coughing and puffing a bit more than usual’ , ‘annoying’ and ‘ having to take it slowly’.

Exacerbations were also perceived as being ‘normal’ temporary fluctuations in asthma that might last a few hours.

The term ‘exacerbation’ was misunderstood by some patients, and while patients with severe asthma were familiar with it, they perceived as too technical and used by health professionals to medicalise and trivialise their condition.

“I actually took offence to it to start with, because I thought, for me to get into hospital, I’m having an attack … it’s not a fricking exacerbation,” one commented.

The study authors said the findings showed that there was a clear gap in language understanding and acceptance between medical practitioners and asthma patients for the terms attack and exacerbation.

If practitioners continue to use the terms exacerbation and flare up this could lead to misunderstandings and poor adherence with management plans and ultimately results in adverse outcomes for patients, they said.

“These data provide important person-centred support to the recommendations of the Lancet Commission  in regard to the use of the term ‘attack’ … adoption of this language may assist in patient-clinician communication and disease and management outcomes,” they concluded.

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