Volume 51, Number 22 February 23, 2004
Hardie -- Recognizing the language of breathlessness
In 1997, Hardie witnessed this firsthand while conducting an asthma study at the University of California at San Francisco where for more than a decade she had been working as an assistant clinical professor in the department of physiological nursing. During the midst of the study, both the son and nephew of an African-American asthma patient died within 24 hours of having sought emergency care at a hospital for their asthma attacks.
"Both were not treated appropriately," said Hardie, most likely because the language they used to describe their asthma symptoms may not have been understood by the health care professionals, she said.
In the United States, the death rate from asthma is three times higher for African Americans than for whites. In addition, African Americans with asthma experience limited access to care, may not receive appropriate treatment in the emergency room, and are at a greater risk of death during acute asthma attacks than whites.
"We've been treating everyone as if they were Caucasian and as if treatments can be one size fits all," said Hardie, who has a doctorate in pulmonary physiology, a master's degree in science as a cardio-pulmonary clinical nurse specialist, and a bachelor's degree in nursing, all from UCSF. "Medical treatment tends to be based on what we know about Caucasians, but symptoms of asthma in other ethnic groups seem to be different."
The tragedies prompted her to continue her research and in 1999, now teaching for the first time in her career as an assistant professor of nursing at SFSU, she and UCSF were awarded the first of multiple grants totaling more than $540,000 from the National Institutes of Health to explore ethnic differences among people with asthma.
Hardie's initial study involved 32 Bay Area residents with asthma and found that words used to describe sensations associated with induced airflow obstruction did indeed differ between African Americans and whites.
Traditionally, physicians and health professionals understand descriptors like "shortness of breath," "chest tightness," and "wheezing" which white patients use to describe breathlessness.
In Hardie's study, participants were asked to describe "in their own words" what symptoms they were experiencing. She and her colleagues found that African Americans sensed symptoms in their upper airways and used words such as "tight throat," "itchy throat," "tough breath" and "voice tight" to describe them. In contrast, whites used lower airway or chest-wall symptom descriptors such as "out of air," "hurts to breathe," "deep breath" and "lightheaded."
"The way we were taught in medical school is not enough," said Dr. Warren M. Gold, who has worked with Hardie on the NIH funded grants and is head of the adult pulmonary function lab at UCSF. "If a patient comes into the emergency room complaining of discomfort in the throat and neck, what he's really talking about are asthma symptoms. But if the doctor doesn't understand this then the white person with asthma will get treated immediately and the black person will get under treated."
The study also examined if the two groups differ in how they perceive and recognize their sensation of breathlessness during airflow obstruction. A better understanding of how people with asthma perceive their symptoms is desirable because it is this perception that determines when or why asthmatics decide to seek medical treatment or go to the emergency room, Hardie said.
The study found that nearly half of all patients failed to perceive that their symptoms were severe enough to use an inhaler or bronchodilator for symptom relief, putting them at risk for experiencing an acute, life threatening asthma episode.
Hardie is now widening the study to 120 subjects, including Caucasians, African Americans, Latinos and Asian Americans. To date, five graduate students from the school of nursing have worked on the studies, gaining first-hand experience at clinical research.
"Grace is driven, honest, hardworking and very dedicated to the research. She has very high standards yet at the same time has an easygoing manner," said Parnaz Abidi, an SFSU nursing graduate who worked with Hardie on the initial phases of the study and also has asthma.
Grandmother of a four-year-old girl, Hardie lives in the East Bay and loves to travel, listen to opera and classical music, play the piano and spend time with her family. This summer she hopes to visit Ireland. Last year she and her family visited Lake Louise and Banff in Canada.
"It was fantastic. No phones, no people, up on a mountaintop. It's heaven."
-- Susan Arthur
Hardie invites Bay Area residents with mild asthma to participate in the study which takes place at UCSF's Moffett Hospital. For more information call 877-532-5532. Or visit Hardie's Web site.
1600 Holloway Avenue, San Francisco,
CA 94132 415/338-1111