Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients?

BACKGROUND: Achieving good asthma control has become the major goal of asthma treatment. Studies have reported a high rate of psychiatric disorders among asthma patients, though the impact of these disorders on asthma control and quality of life remains unexplored. This study evaluated the prevalence of psychiatric disorders in 406 adult asthma patients, and associations between psychiatric status, levels of asthma control, and asthma-related quality of life. METHODS: Consecutive asthma patients presenting to the asthma clinic underwent a brief, structured psychiatric interview, completed the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ), and reported the frequency of bronchodilator use in the past week. All patients underwent standard pulmonary function testing. RESULTS: A total of 34% (n=136) of patients had one or more psychiatric diagnosis, including major depression (15%), minor depression (5%), dysthymia (4%), panic disorder (12%), generalized anxiety disorder (5%), and social phobia (4%). Though there were no differences in pulmonary function, patients with versus without psychiatric disorders had worse ACQ and AQLQ scores and reported greater bronchodilator use, independent age, sex and asthma severity. CONCLUSIONS: Results suggest that psychiatric disorders are prevalent among asthmatics and are associated with worse asthma control and quality of life. Physicians should be aware of the potential risk of poorer asthma control and functional impairment in this population.     

Can disease specific measures for systemic lupus erythematosus predict patients health related quality of life?

Disease specific measures like systemic lupus erythematosus (SLE) Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics (SLICC) and Systemic Lupus Activity Measure (SLAM) are primarily based on physician assessment of disease severity along with blood tests pertinent to SLE. These are primarily used for research purposes and do not quantify the social impact of the disease or measure function and well being from the patients perspective. We wish to study the degree of correlation between the SLEDAI, SLICC and patient reported health related quality of life (HRQOL), to see if these measures can be used to gauge the disease impact from the patient's perspective. The aim of the study was, therefore, to assess the correlation between SLICC, SLEDAI and HRQOL in patients with systemic lupus erythematosus. We utilized the University of Chicago SLE database to obtain SLEDAI, SLICC and MOS SF-36 scores. A physician not directly involved in their care assessed SLEDAI, SLICC and SF-36 at the same visit. STATA-7SE software was used to obtain the two summary scores [physical component summary (PCS) and mental component summary (MCS)]. Multiple linear regression and correlation coefficients were obtained to assess the direction and relationship between HRQOL and these disease specific measures. On multivariate regression models, both SLICC and SLEDAI were predictive of the PCS scores (beta SLICC = - 1.036, P = 0.025, 95% CI - 1.9, -0.13: beta SLEDAI = - 0.322, P = 0.012, 95% CI -0.57, -0.07. R2= 0.14). Neither SLICC nor SLEDAI were predictive of MCS scores (beta SLICC =-0.015, P=0.97, 95% CI -1.03, 1.001: beta SLEDAI=-0.19, P=0.174, 95% CI -0.47, 0.08. R2 = 0.02). The correlation coefficients between SLEDAI and PCS, MCS were -0.29 and -0.15, respectively. The correlation coefficients between SLICC and PCS, MCS were -0.27 and -0.02, respectively. The conclusions are that SLEDAI and SLICC are poor indicators of HRQOL of patients with SLE.     

Health-related quality of life in asthma studies. Can we combine data from different countries?

The aim was to compare health-related quality of life (HRQL) in patients with asthma from 4 countries, and to investigate the correlations between HRQL and clinical indices.341 patients; 140 (Sweden), 54 (Norway), 65 (the Netherlands) and 82 (Greece) were treated with formoterol fumarate 4.5 microg or with terbutaline sulphate 0.5mg for 12 weeks inhaled 'on demand' via Turbuhaler. The Asthma Quality of Life Questionnaire (AQLQ) and clinical indices were assessed.The mean baseline AQLQ overall scores in Sweden (4.97), in the Netherlands (5.04), in Norway (4.68) and in Greece (4.68) were in the same range, however, with a significant difference between the four countries (p=0.038). When comparing AQLQ, activity limitation and symptoms domains, the differences between the countries were not statistically significant. The cross-sectional correlations between AQLQ overall score and the clinical indices were similar in all four countries.The magnitude of change in AQLQ was consistent with the other clinical variables. The correlations between change in AQLQ overall score and change in clinical indices were low to medium in all countries.In conclusion, the consistency of cross-sectional correlations between the AQLQ overall and clinical indices across countries supports the validity of translations of the AQLQ used in this study. There were differences in baseline values between the countries. The treatment response in AQLQ differed to the same extent as other clinical indices. When combining HRQL data from different countries, there might be cultural, gender and socio-economic differences, explaining different responses to treatment.     

Evaluation of asthma control,parents’ quality of life and preference between AeroChamber Plus and AeroChamber Plus Flow-Vu spacers in young children with asthma

Objective: The AeroChamber Plus (AC) valved holding chamber has been enhanced to include the Flow-Vu (FV) inspiratory flow indicator that provides visual inhalation feedback during use. We have investigated if FV alters asthma control and whether parents accept it. Methods: At visit 1, children with asthma, age 1–5 years, used an AC with their pressurised metered dose inhaler and 2 weeks later (visit 2) they were randomised to use either AC or FV. Subjects returned 6 (visit 3) and 12 (visit 4) weeks later. The Asthma Control (ACQ) and Paediatric Asthma Caregiver’s Quality of Life (PACQLQ) questionnaires were scored at each visit, and their peak inhalation flow (PIF) when they used their spacer was measured. Results: Forty participants in each group completed the study. There was no difference in the ACQ scores from visits 2 to 4 between the two groups. The improvements in the PACQLQ scores were greater in the FV group (p?=?0.029). The mean difference (95% confidence interval) for the change from visits 2 to 4 between FV and AC groups was 0.05 (?0.33, 0.43) and 0.39 (0.035, 0.737) for the ACQ and PACQLQ, respectively. Most parents preferred the FV (p?<?0.001). There was no difference in the PIF rates at each visit and between the two spacers. Conclusions: There was no change in asthma control of the young children but that of their parents improved. Parents preferred the FV and this could be related to their improved perception of their children’s asthma control by better PACQLQ scores.     

Does cirrhosis affect quality of life in hepatitis C virus‐infected patients?

Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with impairments in health‐related quality of life. Aims: To evaluate quality of life (QOL) in cirrhotic (compensated and decompensated) and non‐cirrhotic patients with chronic HCV infection, using preference‐based (utilities) and non‐preference‐based methods of evaluating QOL. Methods: In a tertiary care setting, 271 patients completed a self‐administered time trade‐off utility instrument, the Health Utility Index Mark 2 and Mark 3, and the Hepatitis Quality of Life Questionnaire Version 2. Mean QOL scores were compared across HCV disease stages and sociodemographical categories. We examined the association between QOL and disease stage using linear regression adjusting for age, education, marital status, log income and Charlson comorbidity scores. Mean utility scores were compared across disease stages using a propensity score method. Results: Mean utilities were lower than general population norms (0.81–0.92) and ranged from 0.62 to 0.82 in non‐cirrhotic patients (n=197), 0.56–0.84 in compensated cirrhotic patients (n=17) and 0.55–0.76 for decompensated cirrhotic patients (n=57). No significant association found was between disease stage and utility for current health status. Higher income, fewer comorbidities and living in a married or common‐law relationship were significantly associated with higher utilities and better QOL. No significant difference in utilities was found between disease stages using propensity score matching. Conclusions: Our study confirms that changes in HCV disease stage explain only small changes in QOL and suggests that factors such as underlying comorbidities, income and marital status have a greater effect on QOL than disease stage.     

Does self-monitoring by means of symptom diaries improve asthma control in children?

Objective: Keeping symptom diaries on a regular basis may facilitate the execution of symptom-based action plans, enhance the patients’ adherence to treatment program and finally allow better asthma control. We hypothesize that disease control in children who keep symptom diaries regularly would be better compared to children who do not keep symptom diaries regularly. Methods: Asthmatic children, aged between 6 and 17 years, who were monitored at least 2 years at our outpatient clinic and examined at least twice within the last year, were enrolled in this study. The patients were assigned to the following two groups: group I included the patients who keep symptom diaries regularly and group II included the patients who do not keep symptom diaries regularly. Asthma control parameters of patients during the last year were investigated. The number of asthma attacks require systemic corticosteroid use, the frequency of emergency department (ED) admissions and the number of attacks requiring hospitalization, forced expiratory volume in 1?s (FEV₁) values and asthma control test (ACT) scores were compared. Results: 89 (26.2%) of 340 patients included in the study were identified to keep a symptom diary regularly. Although age (p?=?0.20) and sex (p?=?0.48) did not differ significantly between the groups, regular use of anti-inflammatory drug was found to be significantly higher in group I (p?1 did not differ significantly between the groups (p?>?0.05 in all of the parameters). Conclusions: Keeping a symptom diary on a regular basis in asthmatic children was shown to have neither beneficial effect on the day-to-day asthma control nor a decrease in the future risk of asthma control.     

Why evaluate the quality of life in patients with bronchial obstruction?

Quality of life, more precisely health related quality of life, is gaining basic importance in evaluating of patient's health status and results of medical interventions. On the example of patients with bronchial obstruction is demonstrated that quality of life evaluation, although not usually used in clinical practice yet, is in significant correlation with some of usual clinical measures; moreover, it brings otherwise inaccessible information about patient's subjective assessment of his disease and his health situation.     

Measuring asthma quality in primary care: Can we develop better measures?

OBJECTIVE: Asthma is common and commonly under-treated. Currently quality indicators often do not provide specific directions for areas of improvement. This work lays the foundation for a quality improvement initiative that provides practice-specific feedback related directly to clinical activities completed for individual patients with asthma. METHODS: Medical record review using a group of quality assessment elements developed from previous medical record review studies of asthma care and the NAEPP asthma care guidelines. RESULTS: For 500 school children ages 5-18 yr who made one or more asthma visits in the year of interest, the frequency of daytime asthma symptoms were recorded in 54% of patients' medical records at any time during a one-year period, while nighttime symptom frequency was recorded in 33%. Only 12% of medical records recorded any information on missed work, school or activity days. Nine percent recorded information or acknowledged any asthma "triggers". Asthma severity level was documented in only an additional 4% of the children's records. Most medical records documented prescribed asthma medications and dosages (85%) but few recorded the medications or dosages the patients were actually taking. CONCLUSIONS: Many medical records do not include the basic clinical information required to assess asthma severity, adherence to asthma therapy or the response to therapy. This lack of information makes implementation of asthma care guidelines impossible. Therefore, these measures may be useful baseline quality indicators to begin the process of improving asthma care.     

Asthma‐specific quality of life questionnaires in children: Are they useful and feasible in routine clinical practice?

This study used well-validated quality of life (QOL) instruments to compare the QOL scores achieved by children aged 7-17 years with the views of their parents of the effects of their child's asthma on family life. Also, a comparison was made between the child's QOL scores and the judgment of the clinician in charge in regard to asthma control.There was poor correlation between the overall scores of the children and the overall caregiver's score (r = 0.19, P = 0.18), and no correlation between the child's score and assessment of control given by the clinician in charge of the case (r = 0.02, P = 0.98).It is important to recognize that there may be little relationship between the concerns of the child regarding his or her asthma, the effects on the family as reported by a parent, and the clinician's view of asthma control. This recognition may significantly affect treatment planning with the family. The administration of the QOL instrument used in this study was straightforward and quite quick, with a mean time to completion of about 8 min.     

Health status versus quality of life in older patients: does the distinction matter?

PURPOSE: Although health-related quality of life in older people is generally assessed by measuring specific domains of health status, such as activities of daily living or pain, the association between health-status measures and patients' perceptions of their quality of life is not clear. Indeed, it is controversial whether these health-status measures should be considered measures of quality of life at all. Our objective was to determine the association between health-status measures and older patients' perceptions of their global quality of life. SUBJECTS AND METHODS: We performed a cross-sectional study of 493 cognitively intact patients 80 years of age and older, interviewed 2 months after a hospitalization. We measured patients' self-assessed global quality of life and four domains of health status: physical capacity, limitations in performing activities of daily living, psychological distress, and pain. RESULTS: Each of the four scales was significantly correlated with patients' global perceptions of their quality of life (P <0.001). The ability of the health-status scales to discriminate between patients with differing global quality of life was generally good, especially for the physical capacity (c statistic = 0.72) and psychological distress scales (c statistic = 0.70). However, for a substantial minority of patients, scores on the health-status scales did not accurately reflect their global quality of life. For example, global quality of life was described as fair or poor by 15% of patients with the highest (best tertile) physical capacity scores, 25% of patients who were independent in all activities of daily living, 21% of patients with the least psychological distress (best tertile), and by 30% with no pain symptoms. Similarly, global quality of life was described as good or better by 43% of patients with the worst physical capacity (worst tertile), 49% of patients who were dependent in at least two activities of daily living, 47% of patients with the most psychological distress (worst tertile), and 51% of patients with severe pain. CONCLUSION: On average, health status is a reasonable indicator of global quality of life for groups of older patients with recent illness. However, disagreement between patients' reported health status and their perceptions of their global quality of life was common. Therefore, assumptions about the overall quality of life of individual patients should not be based on measures of their health status alone.