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Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Asthma Facts and Figures. Centers for Disease Control and Prevention. Basic Information. Asthma Facts. Brightling et al. Other potential measures to improve QOL in severe asthma Adherence to therapy is a determinant of improved asthma control and hence better QOL in severe asthma. Conclusions In conclusion, severe asthma is detrimental to the quality of life of patients.
Key Notes The most important clinical parameter affecting the QOL of patients with bronchial asthma is disease severity. Funding This is a review article that did not need or receive any funding. Availability of data and materials This is a review article. Notes Ethics approval and consent to participate Not Applicable. Consent for publication Not Applicable.
Competing interests The authors have no competing interests to declare relevant to this work. Contributor Information Elham Hossny, Email: moc.
References 1. Soc Sci Med. Asthma outcomes: quality of life. J Allergy Clin Immunol. Relationship between quality of life and clinical status in asthma: a factor analysis. Eur Respir J. Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol Pract. Understanding asthma-specific quality of life: moving beyond asthma symptoms and severity.
Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Development of the asthma control test: a survey for assessing asthma control. Asthma control test and asthma quality of life questionnaire association in adults. Iran J Allergy Asthma Immunol. Measuring quality of life in children with asthma. Qual Life Res. Hooi LN. What are the clinical factors that affect quality of life in adult asthmatics?
Med J Malaysia. The impact of asthma exacerbations on health-related quality of life in moderate to severe asthma patients in the UK. Prim Care Respir J. Quality of Life and clinical symptoms in asthmatic subjects. J Asthma. Anxiety sensitivity, asthma control, and quality of life in adults with asthma. Asthma and quality of life in adolescents in Manisa, Turkey.
Int J Adolesc Med Health. Quality of life in adolescents with asthma, during the transition period from child to adult. Clin Respir J. J Clin Nurs. Quality of life of adolescents with asthma: the role of personality, coping strategies, and symptom reporting.
J Psychosom Res. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents.
J Bras Pneumol. Disease severity, mental health, and quality of life of children and adolescents with asthma. Pediatr Pulmonol. Asthma severity in children and the quality of life of their parents. Appl Nurs Res. The relationship between asthma severity, family functioning and the health-related quality of life of children with asthma.
Better breathing or better living? A qualitative analysis of the impact of asthma medication acquisition on standard of living and quality of life in low-income families of children with asthma. J Pediatr Health Care. Clinical factors affecting quality of life of patients with asthma. Patient Prefer Adherence. Negative mood and quality of life in patients with asthma. Characterization of asthma endotypes: implications for therapy. Ann Allergy Asthma Immunol. Randomized, double-blind, placebo-controlled study of brodalumab, a human anti-IL receptor monoclonal antibody, in moderate to severe asthma.
Clin Exp Allergy. Exploring the effects of omalizumab in allergic asthma: an analysis of biomarkers in the EXTRA study. High eosinophil count: a potential biomarker for assessing successful omalizumab treatment effects. Estimated asthma exacerbation reduction from omalizumab in a severe eosinophilic asthma population [abstract] J Allergy Clin Immunol. N Engl J Med. Mepolizumab for severe eosinophilic asthma DREAM : a multicentre, double-blind, placebo-controlled trial.
Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.
Lancet Respir Med. Phase 3 study of reslizumab in patients with poorly controlled asthma: effects across a broad range of eosinophil counts. Reslizumab for inadequately controlled asthma with elevated blood eosinophil levels: a randomized phase 3 study. A phase II placebo-controlled study of tralokinumab in moderate-to-severe asthma. Efficacy and safety of tralokinumab in patients with severe uncontrolled asthma: a randomised, double-blind, placebo-controlled, phase 2b trial.
In contrast, less is known about the effect of asthma control level on generic HRQoL. Several population-based studies suggest that the generic HRQoL is lower in patients with uncontrolled asthma compared with controlled asthma 13 , 14 , 17 , 18 , 19 , 36 , 37 , Furthermore, no distinction has been made based on the time of onset childhood vs. Variable ways of determining asthma control have been used, and several studies report only comparisons between uncontrolled and controlled asthma but do not include partially controlled asthma.
We show here for the first time in a clinically confirmed both by respiratory specialist and lung function cohort of patients with adult-onset asthma that uncontrolled asthma defined according to GINA 28 and GINA 29 is associated with clinically and statistically significantly lower generic HRQoL, and this supports the rationale behind the use of such classification in the guidelines.
In fact, a Swedish study recently reported that patients with well-controlled asthma did not differ from non-asthmatic controls when generic HRQoL was evaluated by the SF Health Survey This further supports the idea that good asthma control should be the aim of the therapy.
Using either definition of control, GINA including assessment of symptoms and lung function or GINA based solely on symptoms , a similar difference was found. The GINA definition also includes components for the future risk of exacerbations, and when we included those with a recent history of exacerbations in the uncontrolled group, the results ended up as closely similar.
Depending on what definition was used for uncontrolled asthma, a statistically significant difference was seen in 8—11 out of 15 dimensions assessed, suggesting an effect on most aspects of human life. Patients with at least two exacerbations during the previous years also showed a poorer mean 15D score compared to those with fewer exacerbations, exceeding the clinically important difference 4-fold. Accordingly, in the adjusted model including exacerbations as independent variables, uncontrolled asthma had more profound effects on generic HRQoL compared to having several exacerbations during the previous two years.
However, SGRQ is restricted to components of symptoms, activities that are limited by breathlessness, social functioning and psychological disturbances, whereas 15D measures a wider array of aspects of life. As the only dimension of the 15D significantly deteriorated in patients with partially controlled asthma was the breathing component, it seems possible that the main driver of lower generic HRQoL in patients with partially controlled asthma is related to lung function and respiratory symptoms.
This is further supported by the finding that asthma-specific HRQoL measured by AQ20 was significantly reduced in patients with partially controlled asthma. In the cohort with symptom-based asthma 14 or the cohort with self-reported physician diagnosis of asthma 18 , both partially controlled and uncontrolled asthma defined according to GINA were associated with statistically lower generic HRQoL as evaluated with EQ-5D-3L 18 or SF However, the differences as evaluated by the EQ-5D-3L 18 or in most health domains of SF 14 did not reach the level of accepted minimally important differences.
The difference between their studies and the current study may be due to several factors. This can also be considered a limitation of our study. Another difference is that patients in our cohort represent asthma diagnosed and starting at adult age and include several phenotypes including smoking with unfavourable long-term prognoses 4 , 32 , whereas previous studies also included patients with childhood-onset asthma.
Additionally, both EQ-5D-3L and SF cover fewer aspects of health than the 15D, and contrary to the 15D, they do not include a dimension measuring breathing problems. This casts doubt on the discriminatory power, credibility and thus the validity of the EQ-5D-3L in this patient group. We found that a low 15D score was associated with two comorbidities, depression and treated dyspepsia, and showed borderline association with the number of drugs used to treat comorbidities.
To further support the association between depression and QoL, patients with aspirin-exacerbated respiratory disease AERD showed fewer depressive symptoms and better quality of life compared to other asthma patients, though no difference was seen in asthma control An important difference between our study and previous study was the definition of GERD, which was based on a symptom questionnaire in the previous study 46 and medication in our study.
A connection between multimorbidity and HRQoL evaluated by the EQ-5D-3L has been previously reported 18 , and the association between the number of tablet medications and the HRQoL physical component as evaluated by SF 40 , also supporting our results. Lower 15D score was significantly associated with female sex in our cohort of adult-onset asthma. Poorer generic and disease-specific HRQoL in asthmatic females compared to men were also shown before by using the SF, 15D and mini-AQLQ questionnaires 20 , 47 , 48 , and those results are not surprising, since asthmatic females have been shown to have poorer asthma control, more symptoms, poorer asthma-related quality of life, higher asthma-related healthcare utilization and a higher rate of depression, though with better lung function and a similar level of asthma severity, compared to men 15 , 48 , Generic HRQoL showed a high correlation with subjective disease-specific HRQoL AQ20 and symptoms as measured by ACT but a much weaker correlation with objective measures of asthma such as lung function parameters, consistent with a previous study Smoking was found to be associated with poorer 15D score in a previous study 15 and has been previously associated with uncontrolled asthma 7 , In our study, current smoking was not associated with 15D, but ex-smoking remained of borderline significance.
Our results showed a high correlation between diagnostic and follow-up 15D scores as well as a poorer 15D score at the time of diagnosis in patients with uncontrolled asthma. However, this finding does not explain the poorer HRQoL in patients with uncontrolled asthma, since the association remained even after including baseline 15D score in the same model. In a previous study with asthmatic adults, work-related overcommitment was reported as a predictor of asthma-related quality of life As approximately half of the patients in our cohort were in working life, work-related psychological stress would have been an interesting variable to add, but was not assessed in our study.
Our cohort represents patients with asthma diagnosed at adult age and to our knowledge, no other studies concentrating on a similar population of asthmatics and generic HRQoL exist, but we found a few studies on quality of life in early-onset vs. Given that both EQ-5D-3L and SF scores 14 , 18 have previously been associated with the level of asthma control, it would be tempting to use them as endpoints in clinical studies evaluating the effect of new therapies on asthma control and generic HRQoL.
However, the differences between HRQoL levels in groups with different asthma control, even when comparing patients with controlled and uncontrolled asthma, most often has not reached clinically significant levels 14 , Furthermore, HUI-3, EQ-5D-3L and SF-6D have been reported to be able to differentiate between the highest and lowest levels of self-reported asthma control, but they could not discriminate between the moderate levels In the present study, 15D was able to discriminate well between controlled and uncontrolled asthma, and even the difference between controlled and partially controlled asthma was larger than the minimum clinically important difference This suggests that 15D may be the most useful tool for studies evaluating the effect of a given therapy on asthma control and generic HRQoL.
Taken together, our results show that in clinically confirmed patients with adult-onset asthma, the level of asthma control is associated with generic HRQoL evaluated by the 15D. Uncontrolled asthma was associated with lower generic HRQoL and with a HRQoL reduction on 10 out of 15 dimensions of the 15D: mobility, breathing, sleeping, usual activities, mental function, discomfort and symptoms, depression, distress, vitality and sexual activity.
These results suggest that uncontrolled asthma significantly affects HRQoL and that the effects are not limited to respiratory organs. All data generated or analyzed during this study are included in this published article and its Supplementary Information File.
According to ethical permission and patient data-protection laws of Finland, single patient data cannot be made available. Wenzel, S. Asthma phenotypes: the evolution from clinical to molecular approaches. De Nijs, S. Adult-onset asthma: is it really different? Ilmarinen, P. Mediators Inflamm. Cluster analysis on longitudinal data of patients with adult-onset asthma.
Allergy Clin. Tuomisto, L. Prognosis of new-onset asthma diagnosed at adult age. Outcome and severity of adult onset asthma—report from the obstructive lung disease in northern Sweden studies OLIN. Article Google Scholar. Coons, S. A comparative review of generic quality-of-life instruments. Pharmacoeconomics 17 , 13—35 Wilson, S.
Asthma outcomes: quality of life. Sintonen, H. The 15D instrument of health-related quality of life: properties and applications. Dean, B. The impact of uncontrolled asthma on absenteeism and health-related quality of life. Asthma 46 , — King, M. Measures of asthma control and quality of life: longitudinal data provide practical insights into their relative usefulness in different research contexts. Life Res. Siroux, V. Asthma control assessed in the EGEA epidemiological survey and health-related quality of life.
Braido, F. Uchmanowicz, B. Clinical factors affecting quality of life of patients with asthma. Patient Prefer. Adherence 10 , — Determining whether treatment has had a meaningful impact on HRQoL in the clinical setting requires measurement with reliable and valid tools. In practice, these are infrequently used in severe asthma, largely due to their length, difficult administration and complex scoring structures, rendering them impractical in the clinical setting. Furthermore, a key recommendation of the Food and Drug Administration is that patient-reported outcome measures be fit for purpose, 69 but none of the currently available asthma HRQoL measures have been developed specifically in a severe asthma population.
This highlights a need for the development of fit-for-purpose severe asthma measures that can be easily implemented in the clinic.
That really does not work because they have stronger opinions. The time spent with health care professionals is also important; feeling like the doctor has sufficient time to discuss their problems made patients feel more valued. In a randomised controlled trial, 71 patients with poorly controlled asthma were randomly allocated to shared decision making or clinician decision making. In the shared decision making group, treatment was negotiated with the participants, who had the opportunity to summarise their treatment goals, were provided with information about the necessary treatments for disease control, and were presented with a range of treatment options which enabled them to make a shared decision with the clinician.
This approach resulted in statistically significant improvements in the primary outcome of medication adherence and clinically significant improvements in quality of life compared with those in the clinician decision making group. While novel targeted treatments have indeed had an impact on HRQoL for people with severe asthma, patients continue to experience an excessive burden on their physical, emotional and social functioning.
Future research is required focusing on innovative pharmacological treatment interventions that specifically consider the severe asthma population.
In addition, non-pharmacological and behavioural interventions need to be developed for and tested in populations with severe asthma to examine their impact on HRQoL. Evaluation of multidimensional interventions that target the wide range of disease traits and comorbidities are needed. In order to effectively assess the impact of these interventions on HRQoL, we need patient-reported outcome measures that are developed and validated specifically for people with severe asthma.
Box 1 — Quality of life impacts and practical guide to assessment and intervention. Positive effect size indicates an improvement in asthma control or asthma-related quality of life; negative effect size indicates a reduction in exacerbations.
Provenance: Commissioned; externally peer reviewed. Vanessa McDonald has received speaker fees for unrelated work from AstraZeneca, grants for organising education unrelated to this work from Menarini, and research funds for unrelated work from AstraZeneca and GlaxoSmithKline. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.
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Med J Aust ; 2 : SS Topics Respiratory tract diseases. Social determinants of health. Summary It is largely unrecognised that the impacts of asthma are different in patients with severe disease compared with patients with mild to moderate disease. View this article on Wiley Online Library. McDonald newcastle. Severe asthma: current management, targeted therapies and future directions — a roundtable report.
Respirology ; Uncontrolled asthma: assessing quality of life and productivity of children and their caregivers using a cross-sectional internet-based survey.
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