Objective: Under-perception of airflow limitation is more common in older adults with asthma and may lead to under-reporting of asthma symptoms. Asthma management self-efficacy is linked with better asthma control and quality of life (QoL). We sought to examine asthma and medication beliefs as a mediator in the relationship between both under-perception and self-efficacy with asthma outcomes.

Methods: This cross-sectional study recruited participants with asthma ≥60 years from hospital-affiliated practices in East Harlem and the Bronx, New York. Perception of airflow limitation was measured for 6 weeks by having participants enter peak expiratory flow (PEF) estimates into an electronic peak flow meter followed by PEF blows. We used validated instruments to assess asthma and medication beliefs, asthma management self-efficacy, asthma control, and QoL. Asthma self-management behaviors (SMB) were quantified by electronic and self-report measures of inhaled corticosteroid (ICS) adherence and observation of inhaler technique.

Results: The sample comprised 331 participants (51% Hispanic, 27% Black, 84% female). Beliefs mediated the relationship between greater under-perception and better self-reported asthma control (β = -0.08, p = .02) and better asthma QoL (β =0.12, p = .02). Higher self-efficacy was also associated with better reported asthma control (β = -0.10, p = .006) and better asthma QoL (β =0.13, p = .01) in this indirect effect through beliefs. Accurate perception of airflow limitation was associated with higher adherence to SMB (β = 0.29, p = .003).

Conclusions: Less threatening asthma beliefs may be maladaptive in under-perception of airflow limitation by contributing to under-reporting of asthma symptoms, but adaptive in the context of higher self-efficacy and better asthma control.