The Relationship Between Asthma-Specific Quality of Life and Asthma Control

Few studies have quantitatively addressed the relationship between asthma-specific quality of life and asthma control as assessed by validated tools. Questionnaires were completed at home by a random sample of 542 adult asthmatic patients. The correlations of the two asthma control tools (Asthma Control Test? and Asthma Therapy Assessment Questionnaire?) with the quality of life tool (mini-Asthma Quality of Life Questionnaire) were strongest with the symptoms and activity domains (r = 0.63–0.77); lower with the emotions domain (r = 0.57–0.64); and lowest with the environment domain (r = 0.38–0.43). Asthma control tools reflect the symptoms and activity themes of asthma quality of life well, but reflect the environmental domain less well.     

Asthma treatment and outcomes for children in the emergency department and hospital

Objective: To describe and compare the treatment of acute asthma exacerbations in children given in the emergency department (ED) and admitted to acute care floor in the hospital or intensive care unit (ICU). Methods: A retrospective chart review of visits for acute exacerbation of asthma treated at Phoenix Children's Hospital between January 1, 2014 and December 31, 2016. Results: A total of 287 asthma exacerbation cases were identified including 106 (37%) ED visits, 134 (47%) hospital floor and 47 (16%) ICU admissions. A history of a previous ED visit (ED 88%, Floor 60% and ICU 68%; p < 0.0001) and prior pulmonology inpatient consultation (ED 30%, Floor 19% and ICU 15%; p = 0.05) varied significantly. Pulmonology inpatient consultations were performed more frequently in the ICU than on the hospital floor (54% versus 8%; p < 0.0001). Although overall 145 (51%) of the cases were already on inhaled corticosteroids (ICS) at the time of visit with no differences across locations, ICS initiation/step-up was greater in the ICU (72%) than on the hospital floor (54%) and ED (2%) (p < 0.0001). A recommendation given to the family for follow-up with pulmonology was more frequent for patients who had been admitted to the ICU (68%) as compared to those only admitted to the floor (31%) or ED (4%) (p < 0.0001). Readmission rates were similar for patients previously admitted to the hospital (Floor 42%; ICU 40%), but significantly higher for previous ED visits (77%) (p < 0.0001). Conclusions: Physicians in the ED have an opportunity to provide preventative care in the acute care setting and should be encouraged to initiate treatment with ICS. Consideration should be given to develop a program or clinical pathway focused on long-term asthma management and maintenance to reduce readmissions and long hospital stays.     

Risk factors for repeat attendance at hospital emergency departments among adults and children with asthma

Background: Acute asthma attacks are frequent causes of attendance at hospital Emergency Departments (EDs) and a subgroup of these patients repeatedly present for such treatment.
Aims: This study sought to characterise patients who were repeat attenders at EDs, to assist the targetting of appropriate future interventions aimed at reducing avoidable presentation.
Methods: A cross-sectional survey was undertaken of patients presenting with an asthma attack to the EDs of six teaching hospitals in Adelaide, South Australia between 14 May and 30 June 1994. Patients were interviewed within six weeks of their attendance about aspects of their asthma history, severity, medications, self-management, attitudes and environment. Repeat attenders, defined as two or more visits over the course of the preceding year, were compared with those who reportedly attended on one occasion only, using logistic regression analyses.
Results: Sixty-two per cent of 272 patients aged under 15 years and 40% of 165 patients aged 15 years or more reported having attended two or more times over the course of the preceding year. Among adults, the variables independently associated with repeat attendance principally related to asthma severity. Among children, repeat attendance was associated with parental attitudinal variables relating to appraisal of their child's asthma severity, management of asthma attacks and parental worry.
Conclusions: The factors underlying repeated presentations at EDs differ between adults and children and interventions to minimise avoidable presentation will require different emphasis for these patient subgroups.     

Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey

Background/PurposeElderly patients have higher rates of emergency department visits worldwide. Emergency department utilization by older elderly is much more than younger elderly due to their disease complexity, comorbidities, and severity. This study aimed to determine the sociodemographic and clinical characteristics of elderly patients admitted to the emergency department of a hospital and to compare attendance data regarding older age groups.MethodsAll older people admitted to the emergency department in 2011 were evaluated retrospectively. Patients aged 65–74 years were defined as younger elderly and those aged ≥75 years as older elderly. The prevalence of emergency admission, demographic information, reason for visit, time of admission, diagnosis of disease, and disposition of the two age groups were compared. The Chi-square test was used to analyze data.ResultsThe mean age of the elderly patients was 74.7 ± 6.8 years; 56.7% of them were female. Elderly patients accounted for 11.9% of all emergency department visits. The mean number of emergency department visits per year was 1.15 for older elderly patients and 0.75 for younger elderly patients (p < 0.001). The season in which emergency visits are most frequent was winter, and the most frequent presentation times were evening and night shifts (18:00–23:59 hours). The most common emergency department diagnosis among older and younger elderly patients was related to circulatory disease (26.3% and 21.2%, respectively; p < 0.001). Nearly 90% of the elderly were discharged from the emergency department. Older elderly patients were more likely to be admitted to the hospital than younger elderly patients (14.3% vs. 4.7%).ConclusionThe annual rates of admission to the emergency departments and hospitals were significantly higher in the older elderly population than in the younger elderly population. The most common diagnoses among elderly patients were disorders of the circulatory system.     

Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital

Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2–18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95% had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9–2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.     

The Relationship Between Asthma-Specific Quality of Life and Asthma Control

Few studies have quantitatively addressed the relationship between asthma-specific quality of life and asthma control as assessed by validated tools. Questionnaires were completed at home by a random sample of 542 adult asthmatic patients. The correlations of the two asthma control tools (Asthma Control Test™ and Asthma Therapy Assessment Questionnaire™) with the quality of life tool (mini-Asthma Quality of Life Questionnaire) were strongest with the symptoms and activity domains (r = 0.63-0.77); lower with the emotions domain (r = 0.57-0.64); and lowest with the environment domain (r = 0.38-0.43). Asthma control tools reflect the symptoms and activity themes of asthma quality of life well, but reflect the environmental domain less well.     

The effect of emergency department delay on outcome in critically ill medical patients: evaluation using hospital mortality and quality of life at 6 months

OBJECTIVE: To assess the impact of delay in emergency department (ED) on outcome of critically ill patients admitted to the medical intensive care unit (MICU). Outcome was defined as hospital mortality and as health-related quality of life (HRQoL) at 6 months after intensive care assessed by the 15D measure. The 15D is a generic, 15-dimensional, standardized measure of HRQoL. We hypothesized that prolonged stay in the ED is related to worse outcome. DESIGN AND SETTING: A prospective follow-up cohort study in university hospital. SUBJECTS: All consecutive 1675 patients admitted to the MICU between July 2002 and June 2004. RESULTS: The 15D questionnaire was mailed to all patients alive at 6 months after admission. Of all MICU patients, 64% were admitted from ED. The mean length of stay in the ED was 6.2 h (95%CI 5.9-6.5 h). The hospital mortality rate was 24.4% (20.0% in the ED vs. 33.0% in the non-ED cohort, P < 0.001) and it was associated with higher age and degree of physiological derangement at admission. Neither the length of ED stay was associated with hospital mortality (P = 0.82) nor with HRQoL at 6 months after MICU admission (P = 0.34). Altogether, HRQoL at 6 months was significantly lower compared with the age- and sex-matched general population (P < 0.001). CONCLUSIONS: In a university hospital, the length of ED stay was not associated with the outcome of critically ill medical patients. However, we feel that the effect of ED treatment and delay on outcome and outcome prediction in the critically ill patients deserves further evaluation.     

Comparing the effect of pulmonary rehabilitation in patients with uncontrolled and partially controlled asthma

Objective: Pulmonary rehabilitation (PR) is an important therapeutic approach in asthmatic patients. Lack of asthma control is associated with high morbidity, poor health outcomes, and decrease in quality of life (QOL). However, there is no clear information about the effectiveness of PR in patients with differing levels of asthma control. This study aimed to compare the efficacy of PR in patients with uncontrolled and partially controlled asthma. Methods: Before undergoing an 8-week outpatient PR program, patients were classified according to the asthma control test (ACT) as having partially controlled asthma or uncontrolled asthma. Changes in asthma control, exercise capacity, dyspnea perception, pulmonary function tests, arterial blood gas analysis, QOL, and psychological symptoms before and after PR were compared between groups. Results: A total of 49 patients, 21 of whom were in partially controlled and the rest 28 were in uncontrolled asthma, participated in the study. After PR, asthma control perceived dyspnea, exercise capacity, QOL, anxiety, and depression significantly improved in both groups (p < 0.05). When the two groups were compared in terms of the benefits of PR, the improvement in ACT score was significantly greater in patients with uncontrolled asthma than in partially controlled asthma (p < 0.001), whereas the improvements in other parameters were similar between groups (p > 0.05). Conclusions: Improvement in asthma control is greater in patients with uncontrolled asthma than in patients with partially controlled asthma after PR. Therefore, patients with uncontrolled asthma, in particular, should be given opportunities to benefit from PR programs.     

Use of emergency departments and primary care visits for asthma related conditions in the 3 years following an asthma education program

Background: This study examines changes in Primary Care Visits (PCVs) and Emergency Department Visits (EDVs) among 1918 patients with asthma who attended either two visits, one visit or were no-show referrals at the Dr. Patrick Gill Asthma Education Center (AEC) in Charlottetown Prince Edward Island (PEI) between January 1, 2003 and March 31, 2008 compared to 2799 controls selected from a list of PEI asthma patients developed for the Canadian Chronic Disease Surveillance System (CCDSS). Methods: Hurdle regression was used to model counts of PCVs and negative binomial models were used to model counts of EDVs at 12 months prior to AEC contact and 0–1, >1 to 2 and >2 to 3 years after AEC contact. The PEI Research Board approved the project. Results: No-show referrals had a significant increase in pediatric EDVs and PCVs in the first year after referral. The higher rates of PCVs and EDVs prior to contact with the AEC in patients referred to the AEC were reduced after contact with the AEC, although they remained significantly higher than the CCDSS controls. Conclusions: Compared to patients who attended the AEC, referred patients who did not attend the AEC did not achieve similar reductions in pediatric EDVs and PCVs in the first year after referral.     

哮喘控制问卷与哮喘生命质量问卷在哮喘患者中的应用价值研究

目的探讨哮喘控制问卷（ACQ）与哮喘生命质量问卷（AQLQ）在哮喘患者中的应用价值。方法选取中国医科大学附属第一医院呼吸内科就诊的哮喘患者132例,其中男性60例,女性72例,平均年龄（47．64-12．3）岁。所有患者填写ACQ、AQLQ问卷并完成肺功能测试。按FEV-％pred将患萏分为三组：1组FEVi％pred≥80％;2组60％≤FEV1％pred〈80％;3组FEV1％pred〈60％。采用Pearson相关分析ACQ分值、AQLQ分值与肺功能指标之间的相关性。结果3组患者的ACQ、AQLQ评分差异有统计学意义（F：32．27、4．65,P〈0．01）,且ACQ、AQI。Q评分能很好的反映肺功能的差异。ACQ评分与肺功能指标呈负相关,AQI。Q评分与肺功能指标呈正相关。结论哮喘患者的肺功能指标与ACQ评分、AQLQ评分有很好的相关性,能更准确的评价患者病情,ACQ与AQLQ在哮喘患者中有很好的应用价值。     

Depressive symptomatology,quality of life and disease control among individuals with well-characterized severe asthma

Abstract

Objectives: A thorough examination of the relationship of asthma severity and control with symptoms of depression is needed to identify groups of asthmatics at high risk for poor disease control outcomes. This study examines the relationship of symptoms of depression with severity and control in a well-characterized cohort of asthmatics and healthy controls. Methods: Depressive symptoms and quality of life were assessed using the Beck Depression Inventory. Disease control was measured by a composite index incorporating symptoms, activity limitation and rescue medication use. Results: Individuals with asthma (n?=?91) reported more symptoms of depression than controls (n?=?36; p?<?0.001). Those with severe asthma (n?=?49) reported more symptoms of depression (p?=?0.002) and poorer asthma control (p?<?0.0001) than those with not severe asthma. Worse asthma control was associated with more depressive symptoms in severe (r?=?0.46, p?=?0.002) but not in not severe (r?=?0.13, p?=?0.40) asthmatics. The relationship of symptoms of depression among severe asthmatics was attenuated by disease control. Exploratory analyses identified specific disease symptom characteristics, as opposed to exacerbations, as associated with symptoms of depression. Conclusions: Among individuals with severe asthma, increased symptom burden is positively associated with risk for co-morbid depression. These findings point to a need for regular mood disorder screenings and treatment referrals among this group. Further research is warranted to examine whether treatment of comorbid depression improves treatment adherence and asthma-related quality of life.     

The association of environmental,meteorological, and pollen count variables with asthma-related emergency department visits and hospitalizations in the Bronx

Objective: To better understand how meteorological variables, air quality variables, and pollen counts collectively contribute to asthma-related emergency department visits (AREDV) and asthma-related hospitalizations (ARH) among pediatric and adult patients in the New York City borough of the Bronx. Methods: The numbers of daily adult and pediatric AREDV and ARH from 2001 to 2008 were obtained from three Bronx hospitals. After removing outliers, interpolating missing data, and standardizing variable values by scaling the data using z-scores, data were analyzed using Spearman rank tests and linear regression models for the full year and each season. Results: There were a total of 42,065 AREDV and 1,664 ARH at both Bronx hospitals. With the exception of a spring peak in AREDVs, AREDVs and ARHs follow a cyclical pattern, climbing in the fall, plateauing in the winter, dropping in the spring, and reaching a low in the summer. Among the 11 air quality, meteorological, and pollen count variables, temperature and tree pollen made the greatest contribution to AREDV with scaled coefficients of –0.337 and 0.311 respectively; equating to an additional AREDV for every 5.0-unit decrease in temperature and an additional AREDV for every 186.0-unit increase in tree pollen. These two variables were confirmed to have independent associations with AREDV prior to the data interpolation. Grass pollen was also found to have a relatively large contribution to AREDV during the summer with a scaled coefficient of 0.314, equating to an additional AREDV for every 2.3-unit increase in grass pollen. Conclusion: There are distinct peaks of increased AREDVs that are closely associated with increased tree pollen counts in the spring and decreasing temperatures in the fall. Early anticipation of these air quality, meteorological, and pollen factor changes based on ongoing surveillance could potentially guide clinical practice and minimize AREDVs in the Bronx.     

三位一体支气管哮喘教育管理模式对病情控制水平和生命质量的影响

目的评估三位一体支气管哮喘(简称哮喘)教育管理模式对患者病情控制水平和哮喘生命质量的影响。方法北京大学人民医院三位一体哮喘教育管理模式由哮喘专业门诊、哮喘宣教中心和哮喘患者协会构成。2005年4月至6月选择北京大学人民医院接受三位一体哮喘教育管理的门诊患者为教育组(56例);选择另一家三级医院未接受系统哮喘教育管理的门诊患者为对照组(30例)。采用面对面问卷方式调查两组近8周的病情控制水平和生命质量评分并进行对比分析。结果两组病情的良好控制率分别为61%(34例)和10%(3例),教育组优于对照组,差异有统计学意义(χ2=20.50,P<0.01);两组哮喘患者生命质量总评分分别为(155±12)分、(132±24)分,教育组亦优于对照组,差异有统计学意义(t=5.17,P<0.01)。结论三位一体哮喘教育管理模式可以有效提高哮喘患者的病情控制水平和哮喘生命质量。     

Health-related Quality of Life in College Students with and without Childhood-Onset Asthma

Objective. The current study investigated whether differences existed in health-related quality of life between individuals who self-identified as having childhood-onset asthma and individuals without a chronic illness. Additionally, the relationship between perceived illness intrusiveness and illness uncertainty to health-related quality of life was explored. Methods. College undergraduates at least 18 years of age who self-identified as having childhood asthma were randomly matched by age and gender to healthy control participants. Participants completed a demographic form, the Mishel Uncertainty in Illness Scale-Community Form, the Illness Intrusiveness Scale, and the SF-36 Health Survey, a measure of health-related quality of life. Results. Participants with asthma had significantly lower scores on the total and mental health-related quality of life scales than did healthy control subjects. There were no significant differences between self-identified participants with asthma and matched healthy control subjects on physical health-related quality of life scales. Illness intrusiveness was not related to either the physical (e.g., physical functioning, general health) or mental health-related quality of life. Higher levels of illness uncertainty were significantly related to higher levels of mental health-related quality of life (e.g., vitality, mental health). In addition, participants with asthma scored significantly lower than healthy controls on the social functioning and role-emotional subscales. Conclusion. The current study adds to the extant literature by examining the relationships between illness intrusiveness, illness uncertainty, and health-related quality of life among a young adult population. College students with asthma appear to be at risk for diminished quality of life compared to a healthy comparison group. Further examination of various domains of health-related quality of life among older adolescents and young adults with childhood asthma is needed.     

Assessment of impairment in health-related quality of life in patients with difficult asthma: psychometric performance of the Asthma Quality of Life Questionnaire

OBJECTIVE AND BACKGROUND: To understand the effects of asthma and its treatment and to draw accurate conclusions with respect to different management programmes, including clinical trials. In more severe asthmatics, it is imperative that the health-related quality of life (HRQL) be measured accurately and validly. This study had a twofold objective: (i) to examine the psychometric characteristics of the Asthma Quality of Life Questionnaire (AQLQ) in patients with difficult asthma, and (ii) to explore to what extent suffering from asthma affects the HRQL in patients with difficult asthma. METHODS: Eighty-six adult patients with difficult asthma (33 men) participated in the study. RESULTS: The internal consistency reliability (alpha) ranged from 0.80 (environment subscale) to 0.96 (overall score), and the 2- to 4-week reproducibility (intraclass correlation coefficients) ranged from 0.82 (environment subscale) to 0.92 (overall score).The AQLQ correlated significantly with an asthma disease severity scale, the EQ-5D, and the visual analogue scale indicator of global quality of life (P < 0.0001). No relationship was found between the AQLQ score and FEV1%. CONCLUSIONS: The results suggest that the AQLQ may be a useful outcome measure for clinical trials in severe asthmatics. The results of this study showed that the HRQL in patients with difficult asthma is substantially impaired. The dominant feature of this group is high symptom scores, with environmental exposure scoring lowest. Mean AQLQ values for this group compared with published means from other less severe asthmatics suggest that patients with difficult asthma experience clinically significant, poorer health-related quality of life. This study presents the poorest health-related quality of life reported in patients with asthma.     

哮喘慢性持续期患者肺功能与生存质量的相关性

目的探讨哮喘慢性持续期患者肺功能与生存质量的相关性。方法统计分析2012年5月至2014年5月贺州市人民医院呼吸内科收治的100例支气管哮喘患者的临床资料。结果和治疗前相比,治疗后两组患者的FEV1、FEV1%、PEF、PEF%、AQLQ、日间和夜间症状评分均明显升高(P0.05);和乙组患者相比,甲组患者治疗前后的FEV1、FEV1%、PEF、PEF%、AQLQ、日间和夜间症状评分均明显升高(P0.05);两组患者治疗前后的AQLQ与FEV1%、PEF%均呈显著的正相关关系(P0.05)。结论哮喘慢性持续期患者肺功能与生存质量呈显著的正相关关系,患者病情严重程度能够在两者的联系中得到全面的反映。