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de Albornoz SC, Chen G. Relationship between health-related quality of life and subjective wellbeing in asthma. J Psychosom Res 2021; 142:110356. [PMID: 33454566 DOI: 10.1016/j.jpsychores.2021.110356] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/17/2020] [Accepted: 01/02/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor health-related quality of life (HRQoL) is associated with a high risk of acute exacerbations in patients with asthma. The use of health state utility instruments to measure HRQoL is common, but it has been criticised for failing to adequately capture the impact of the condition from the patient perspective. We aimed to assess the ability of subjective wellbeing and health state utility instruments to capture important HRQoL dimensions for asthma patients. METHODS Regression analyses were conducted using data (n = 856 asthma patients) from a large multi-national cross-sectional survey to explore the relationship between subjective wellbeing (ONS4, PWI, SWLS), health state utility (15D, AQoL-8D, EQ-5D-5L, HUI3, SF-6D, SF-6Dv2), and an asthma-specific instrument (AQLQ-S). The latent structure of different instruments was investigated using an exploratory factor analysis. RESULTS All instruments could distinguish the impact of asthma on HRQoL. Among health utility instruments, 15D, SF-6D and AQoL-8D were more sensitive based on the average standardised regression coefficients. AQOL-8D had the strongest correlation with subjective wellbeing. Nevertheless, the exploratory factor analysis showed a complementary relationship between subjective wellbeing and HRQoL instruments. The most important subjective wellbeing domains were standard of living, achieving in life, and personal relationships; although contributions of these domains to overall life satisfaction differed among asthma patients identified by a latent class analysis. CONCLUSION The use of subjective wellbeing alongside AQLQ-S and health state utility instruments provides a comprehensive approach to assess the impact of asthma on the patient's life. Further research is needed to incorporate these measures in health care evaluation.
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Affiliation(s)
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia.
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2
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Després F, Ducharme FM, Forget A, Tse SM, Kettani FZ, Blais L. Development and validation of a Pharmacoepidemiologic Pediatric Asthma Control Index (PPACI) using administrative data. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2020.1727789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- François Després
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Francine M. Ducharme
- Research Center, Sainte-Justine University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
- Department of Social and Preventive Medecine, Université de Montréal, Montreal, Québec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
- Department of Social and Preventive Medecine, Université de Montréal, Montreal, Québec, Canada
| | - Sze Man Tse
- Research Center, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Fatima-Zohra Kettani
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
- Department of Social and Preventive Medecine, Université de Montréal, Montreal, Québec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
- Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Québec, Canada
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3
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Shi X, Buysse DJ, Ritterband LM, Sereika SM, Strollo PJ, Wenzel SE, Luyster FS. Solving insomnia electronically: Sleep treatment for asthma (SIESTA): A study protocol for a randomized controlled trial. Contemp Clin Trials 2019; 79:73-79. [PMID: 30825525 PMCID: PMC6563833 DOI: 10.1016/j.cct.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic insomnia is associated with poor asthma control. Cognitive-behavioral treatment for insomnia (CBT-I) is an efficacious and durable treatment for comorbid insomnia in medical and psychiatric disorders. However, the efficacy and potential accompanying mechanisms of CBT-I have not been examined in asthma. The purpose of this study is to test the efficacy of a CBT-I intervention on sleep and asthma control in adults with insomnia and asthma. We will also explore airway inflammation (i.e., exhaled nitric oxide, blood eosinophils) as a potential biological mechanism linking improvements in sleep with improvements in asthma control. METHODS The study is a single center, parallel group, randomized controlled trial. Two hundred and ten adults with insomnia and asthma that is not well-controlled will be randomized to either a 9-week Internet-based CBT-I program (Sleep Healthy Using the Internet (SHUTi)) or an enhanced usual care condition which utilizes an online educational video about insomnia. The primary sleep outcome is insomnia severity measured by the Insomnia Severity Index. Secondary sleep outcomes are sleep quality and wrist actigraph-recorded sleep parameters. Asthma control will be assessed by the Asthma Control Test, Asthma Quality of Life Questionnaire, pulmonary function testing, and self-report of asthma exacerbations and asthma-related healthcare utilization. Treatment outcomes will be measured at baseline, 9 weeks, and 6 months. DISCUSSION This trial has the potential to identify a novel strategy for improving asthma control. Findings may advocate for the inclusion of treatment of comorbid insomnia into current asthma management practice guidelines.
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Affiliation(s)
- Xiaojun Shi
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Daniel J Buysse
- Department of Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Lee M Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Sally E Wenzel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Faith S Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States of America.
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4
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Polivka BJ, Folz R, Myers J, Barnett R, Antimisiaris D, Jorayeva A, Beatty B. Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results. Res Nurs Health 2019; 41:336-345. [PMID: 30357896 DOI: 10.1002/nur.21880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/22/2018] [Indexed: 01/05/2023]
Abstract
Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are ≥60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.
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Affiliation(s)
| | - Rodney Folz
- Case Western Reserve University and University Hospital, Cleveland, Ohio
| | - John Myers
- Department of Pediatrics, University of Louisville School, Louisville, Kentucky
| | | | - Demetra Antimisiaris
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Anna Jorayeva
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Bryan Beatty
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
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5
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Blonshine J, Cruz J, Sajnic A, De Brandt J. European Respiratory Society International Congress best abstract preview from the allied respiratory professionals from assembly 9. J Thorac Dis 2018; 10:S3010-S3016. [PMID: 30310691 DOI: 10.21037/jtd.2018.08.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal.,Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Andreja Sajnic
- Department for Respiratory Diseases "Jordanovac", University Hospital Center, Zagreb, Croatia
| | - Jana De Brandt
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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6
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González-Freire B, Vázquez I. Quality of life in adults with asthma treated in allergy and pneumology subspecialties: relationship with sociodemographic, clinical and psychological variables. Qual Life Res 2016; 26:635-645. [PMID: 28028697 DOI: 10.1007/s11136-016-1486-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Prior studies suggest that specialist care associates with improved health-related quality of life (HRQL) in asthmatic patients. However, there are limited studies focused on differences in HRQL among subspecialties. The aim of this study was to assess the differences in HRQL between adult asthmatic patients treated in pneumology or allergy practices, and to estimate to what extent the differences in HRQL can be explained by sociodemographic, clinical or psychological characteristics of patients from each specialty. METHODS We recruited adult asthmatic outpatients from allergy and pneumology practices. Information on sociodemographic, clinical and psychological characteristics was collected, and HRQL was assessed with generic and disease-specific questionnaires. HRQL was compared between groups adjusting for sociodemographic, clinical and psychological characteristics. RESULTS A total of 287 asthmatic patients participated in the study (105 from pneumology and 182 from allergy). Patients treated by pneumologists reported significantly poorer HRQL in physical dimensions of generic questionnaire and all dimensions of disease-specific questionnaire. Pneumology patients were older (p < .001) and had a lower education level (p < .001); a higher number of patients were in a non-active employment situation (p = .003) and had worse pulmonary function (p < .001), longer duration of disease (p = .020), higher prevalence of obesity (p < .001) and uncontrolled asthma (p < .001), and a higher rate of previous absenteeism (p = .001). Depression and the use of cognitive avoidance coping were also higher among pneumology patients (p = .050 and p = .022, respectively). There were not significant differences in HRQL between pneumology and allergy patients after adjustment for these sociodemographic, clinical and psychological characteristics. CONCLUSIONS Asthmatic patients treated by pneumologists reported poorer HRQL than patients treated by allergists, but this outcome is attributed to differences in several sociodemographic, clinical and psychological characteristics between the two groups of patients.
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Affiliation(s)
- Beatriz González-Freire
- Private Psychological Practice Beatriz González Freire. Psicóloga, Ourense, Spain.,Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain.
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7
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Cano-Garcinuño A, Mora-Gandarillas I, Bercedo-Sanz A, Callén-Blecua MT, Castillo-Laita JA, Casares-Alonso I, Forns-Serrallonga D, Tauler-Toro E, Alonso-Bernardo LM, García-Merino Á, Moneo-Hernández I, Cortés-Rico O, Carvajal-Urueña I, Morell-Bernabé JJ, Martín-Ibáñez I, Rodríguez-Fernández-Oliva CR, Asensi-Monzó MT, Fernández-Carazo C, Murcia-García J, Durán-Iglesias C, Montón-Álvarez JL, Domínguez-Aurrecoechea B, Praena-Crespo M. Looking beyond patients: Can parents' quality of life predict asthma control in children? Pediatr Pulmonol 2016; 51:670-7. [PMID: 26599570 DOI: 10.1002/ppul.23336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/06/2015] [Accepted: 10/10/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Social and family factors may influence the probability of achieving asthma control in children. Parents' quality of life has been insufficiently explored as a predictive factor linked to the probability of achieving disease control in asthmatic children. OBJECTIVE Determine whether the parents' quality of life predicts medium-term asthma control in children. METHODS Longitudinal study of children between 4 and 14 years of age, with active asthma. The parents' quality of life was evaluated using the specific IFABI-R instrument, in which scores were higher for poorer quality of life. Its association with asthma control measures in the child 16 weeks later was analyzed using multivariate methods, adjusting the effect for disease, child and family factors. RESULTS The data from 452 children were analyzed (median age 9.6 years, 63.3% males). The parents' quality of life was predictive for asthma control; each point increase on the initial IFABI-R score was associated with an adjusted odds ratio (95% confidence interval) of 0.56 (0.37-0.86) for good control of asthma on the second visit, 2.58 (1.62-4.12) for asthma exacerbation, 2.12 (1.33-3.38) for an unscheduled visit to the doctor, and 2.46 (1.18-5.13) for going to the emergency room. The highest quartile for the IFABI-R score had a sensitivity of 34.5% and a specificity of 82.2% to predict poorly controlled asthma. CONCLUSIONS Parents' poorer quality of life is related to poor, medium-term asthma control in children. Assessing the parents' quality of life could aid disease management decisions. Pediatr Pulmonol. 2016;51:670-677. © 2015 Wiley Periodicals, Inc.
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8
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Behr JG, Diaz R, Akpinar-Elci M. Health Service Utilization and Poor Health Reporting in Asthma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E645. [PMID: 27376308 PMCID: PMC4962186 DOI: 10.3390/ijerph13070645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED The management and treatment of adult asthma has been associated with utilization of health services. OBJECTIVES First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. DATA SOURCE Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). STUDY DESIGN Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. FINDINGS Those with asthma are found more likely (OR 1.50, 95% CI 1.05-2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56-11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32-2.65) and hospitalization (OR 2.21, 95% CI 1.39-3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. CONCLUSION Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of both primary and emergency department care as the threshold for what constitutes frequent utilization increases. Investments in prevention and better management of the chronic condition may result in less demand for acute care services, especially among high frequency utilizers.
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Affiliation(s)
- Joshua G Behr
- Virginia Modeling, Analysis and Simulation Center, Old Dominion University, Norfolk, VA 23529, USA.
| | - Rafael Diaz
- MIT-Zaragosa Logistics Center, Massachusetts Institute of Technology, Zaragoza 50197, España.
| | - Muge Akpinar-Elci
- Center for Global Health, Old Dominion University, Norfolk, VA 23529, USA.
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9
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Ryan JL, McGrady ME, Guilfoyle SM, Follansbee-Junger K, Peugh JL, Loiselle KA, Arnett AD, Modi AC. Quality of Life Changes and Health Care Charges Among Youth With Epilepsy. J Pediatr Psychol 2015; 41:888-97. [PMID: 26503299 DOI: 10.1093/jpepsy/jsv098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine differences in health care charges following a pediatric epilepsy diagnosis based on changes in health-related quality of life (HRQOL). METHODS Billing records were obtained for 171 youth [M (SD) age = 8.9 (4.1) years] newly diagnosed with epilepsy. Differences in health care charges among HRQOL groups (stable low, declining, improving, or stable high as determined by PedsQL(™) scores at diagnosis and 12 months after diagnosis) were examined. RESULTS Patients with persistently low or declining HRQOL incurred higher total health care charges in the year following diagnosis (g = .49, g = .81) than patients with stable high HRQOL after controlling for epilepsy etiology, seizure occurrence, and insurance type. These relationships remained consistent after excluding health care charges for behavioral medicine or neuropsychology services (g = .49, g = .80). CONCLUSIONS Monitoring HRQOL over time may identify youth with epilepsy at particular risk for higher health care charges.
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Affiliation(s)
- Jamie L Ryan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Shanna M Guilfoyle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Kristin A Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Alex D Arnett
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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10
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Nelson KA, Garbutt JM, Wallendorf MJ, Trinkaus KM, Strunk RC. Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children. J Asthma 2014; 51:907-12. [PMID: 24894745 DOI: 10.3109/02770903.2014.927483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association between numbers of primary care provider (PCP) visits for asthma monitoring (AM) over time and acute asthma visits in the emergency department (ED) and at the PCP for Medicaid-insured children. METHODS We prospectively enrolled 2-10 years old children during ED asthma visits. We audited hospital and PCP records for each subject for three consecutive years. We excluded subjects also receiving care from asthma subspecialists. PCP AM visits were those with documentation that suggested discussion of asthma management but no acute asthma symptoms or findings. PCP "Acute Asthma" visits were those with documentation of acute asthma symptoms or findings, regardless of treatment. ED asthma visits were those with documented asthma treatment. Generalized liner models were used to analyze the association between numbers of AM visits and acute asthma visits to the ED and PCP. RESULTS One hundred three subjects were analyzed. Over the 3 years, the mean number of AM visits/child was 2.5 ± 2.3 (standard deviation), range 0-10. Only 50% of subjects had at least 1 PCP visit with an asthma controller medication documented. The mean number of ED asthma visits/child was 3.2 ± 2.8; range 1-18. The mean number of PCP Acute Asthma visits/child was 0.7 ± 1.6; range 0-11. Increasing AM visits was associated with more ED visits (estimate 0.088; 95% CI 0.001, 0.174), and more PCP Acute Asthma visits (estimate 0.297; 95% CI 0.166, 0.429). Increasing PCP visits for any diagnosis was not associated with ED visits (estimate 0.021; 95% CI -0.018, 0.06). CONCLUSIONS Asthma monitoring visits and documented controller medication for these urban Medicaid-insured children occurred infrequently over 3 years, and having more asthma monitoring visits was not associated with fewer ED or PCP acute asthma visits.
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Affiliation(s)
- Kyle A Nelson
- Department of Emergency Medicine, Boston Children's Hospital , Boston , USA
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Pastis NJ, Silvestri GA, Shepherd RW. Quality-of-life improvement and cost-effectiveness of interventional pulmonary procedures. Clin Chest Med 2013; 34:593-603. [PMID: 23993826 DOI: 10.1016/j.ccm.2013.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most interventional pulmonology studies focus on the technical success of procedures without measuring validated quality-of-life (QoL) outcomes. Studies are now incorporating end points that include QoL measurements and there are examples of interventional procedures that likely improve QoL. It is vital for the interventional pulmonary literature to incorporate cost-effectiveness when introducing new technology. While not uniformly analyzed in a rigorous manner in all studies, there are examples of interventional pulmonary studies that analyze cost-effectiveness through avoidance of more expensive procedures, cost savings per day free of emergency room visit, or cost savings per day not requiring intensive care unit care.
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Affiliation(s)
- Nicholas J Pastis
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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12
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Blanco-Aparicio M, Vázquez I, Pita-Fernández S, Pértega-Diaz S, Verea-Hernando H. Utility of brief questionnaires of health-related quality of life (Airways Questionnaire 20 and Clinical COPD Questionnaire) to predict exacerbations in patients with asthma and COPD. Health Qual Life Outcomes 2013; 11:85. [PMID: 23706146 PMCID: PMC3701555 DOI: 10.1186/1477-7525-11-85] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is some evidence that quality of life measured by long disease-specific questionnaires may predict exacerbations in asthma and COPD, however brief quality of life tools, such as the Airways Questionnaire 20 (AQ20) or the Clinical COPD Questionnaire (CCQ), have not yet been evaluated as predictors of hospital exacerbations. OBJECTIVES To determine the ability of brief specific health-related quality of life (HRQoL) questionnaires (AQ20 and CCQ) to predict emergency department visits (ED) and hospitalizations in patients with asthma and COPD, and to compare them to longer disease-specific questionnaires, such as the St George´s Respiratory Questionnaire (SGRQ), the Chronic Respiratory Disease Questionnaire (CRQ) and the Asthma Quality of Life Questionnaire (AQLQ). METHODS We conducted a two-year prospective cohort study of 208 adult patients (108 asthma, 100 COPD). Baseline sociodemographic, clinical, functional and psychological variables were assessed. All patients completed the AQ20 and the SGRQ. COPD patients also completed the CCQ and the CRQ, while asthmatic patients completed the AQLQ. We registered all exacerbations that required ED or hospitalizations in the follow-up period. Differences between groups (zero ED visits or hospitalizations versus ≥ 1 ED visits or hospitalizations) were tested with Pearson´s X(2) or Fisher´s exact test for categorical variables, ANOVA for normally distributed continuous variables, and Mann-Whitney U test for non-normally distributed variables. Logistic regression analyses were performed to estimate the predictive ability of each HRQoL questionnaire. RESULTS In the first year of follow-up, the AQ20 scores predicted both ED visits (OR: 1.19; p = .004; AUC 0.723) and hospitalizations (OR: 1.21; p = .04; AUC 0.759) for asthma patients, and the CCQ emerged as independent predictor of ED visits in COPD patients (OR: 1.06; p = .036; AUC 0.651), after adjusting for sociodemographic, clinical, and psychological variables. Among the longer disease-specific questionnaires, only the AQLQ emerged as predictor of ED visits in asthma patients (OR: 0.9; p = .002; AUC 0.727). In the second year of follow-up, none of HRQoL questionnaires predicted exacerbations. CONCLUSIONS AQ20 predicts exacerbations in asthma and CCQ predicts ED visits in COPD in the first year of follow-up. Their predictive ability is similar to or even higher than that of longer disease-specific questionnaires.
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Affiliation(s)
| | - Isabel Vázquez
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Salvador Pita-Fernández
- Unidad de Epidemiología Clínica y Bioestadística, Complejo Hospitalario, Universitario A Coruña, A Coruña, Spain
| | - Sonia Pértega-Diaz
- Unidad de Epidemiología Clínica y Bioestadística, Complejo Hospitalario, Universitario A Coruña, A Coruña, Spain
| | - Héctor Verea-Hernando
- Servicio de Neumología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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13
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Iribarren C, Tolstykh IV, Miller MK, Sobel E, Eisner MD. Adult asthma and risk of coronary heart disease, cerebrovascular disease, and heart failure: a prospective study of 2 matched cohorts. Am J Epidemiol 2012; 176:1014-24. [PMID: 23139248 DOI: 10.1093/aje/kws181] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Asthma has been associated with increased cardiovascular disease (CVD) risk. The authors ascertained the association of asthma with CVD and the roles that sex, concurrent allergy, and asthma medications may play in this association. They assembled a cohort of 203,595 Northern California adults with asthma and a parallel asthma-free referent cohort (matched 1:1 on age, sex, and race/ethnicity); both cohorts were followed for incident nonfatal or fatal CVD and all-cause mortality from January 1, 1996, through December 31, 2008. Each cohort was 66% female and 47% white. After adjustment for age, sex, race/ethnicity, cardiac risk factors, and comorbid allergy, asthma was associated with a 1.40-fold (95% confidence interval (CI): 1.35, 1.45) increased hazard of coronary heart disease, a 1.20-fold (95% CI: 1.15, 1.25) hazard of cerebrovascular disease, a 2.14-fold (95% CI: 2.06, 2.22) hazard of heart failure, and a 3.28-fold (95% CI: 3.15, 3.41) hazard of all-cause mortality. Stronger associations were noted among women. Comorbid allergy predicted CVD but did not synergistically increase the CVD risk associated with asthma. Only asthma patients using asthma medications (particularly those on oral corticosteroids alone or in combination) were at enhanced risk of CVD. In conclusion, asthma was prospectively associated with increased risk of major CVD. Modifying effects were noted for sex and asthma medication use but not for comorbid allergy.
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Affiliation(s)
- Carlos Iribarren
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA.
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14
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Knoeller GE, Mazurek JM, Moorman JE. Health-related quality of life among adults with work-related asthma in the United States. Qual Life Res 2012; 22:771-80. [PMID: 22661107 DOI: 10.1007/s11136-012-0206-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study was to examine health-related quality of life among adults with work-related asthma. METHODS We analyzed 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance. RESULTS Of ever-employed adults with current asthma, an estimated 9.0% had work-related asthma, 26.9 % had poor self-rated health, 20.6% had impaired physical health, 18.2% had impaired mental health, and 10.2% had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95% confidence interval (CI), 1.31-1.60], impaired physical health (PR, 1.60; 95% CI, 1.42-1.80), impaired mental health (PR, 1.55; 95% CI, 1.34-1.80), and activity limitation (PR, 2.16; 95% CI, 1.81-2.56). CONCLUSIONS Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.
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Affiliation(s)
- Gretchen E Knoeller
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), 1095 Willowdale Rd., MS HG-900, Morgantown, WV 26505, USA.
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15
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Poon JL, Zhou ZY, Doctor JN, Wu J, Ullman MM, Ross C, Riske B, Parish KL, Lou M, Koerper MA, Gwadry-Sridhar F, Forsberg AD, Curtis RG, Johnson KA. Quality of life in haemophilia A: Hemophilia Utilization Group Study Va (HUGS-Va). Haemophilia 2012; 18:699-707. [PMID: 22507546 DOI: 10.1111/j.1365-2516.2012.02791.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study describes health-related quality of life (HRQoL) of persons with haemophilia A in the United States (US) and determines associations between self-reported joint pain, motion limitation and clinically evaluated joint range of motion (ROM), and between HRQoL and ROM. As part of a 2-year cohort study, we collected baseline HRQoL using the SF-12 (adults) and PedsQL (children), along with self-ratings of joint pain and motion limitation, in persons with factor VIII deficiency recruited from six Haemophilia Treatment Centres (HTCs) in geographically diverse regions of the US. Clinically measured joint ROM measurements were collected from medical charts of a subset of participants. Adults (N = 156, mean age: 33.5 ± 12.6 years) had mean physical and mental component scores of 43.4 ± 10.7 and 50.9 ± 10.1, respectively. Children (N = 164, mean age: 9.7 ± 4.5 years) had mean total PedsQL, physical functioning, and psychosocial health scores of 85.9 ± 13.8, 89.5 ± 15.2, and 84.1 ± 15.3, respectively. Persons with more severe haemophilia and higher self-reported joint pain and motion limitation had poorer scores, particularly in the physical aspects of HRQoL. In adults, significant correlations (P < 0.01) were found between ROM measures and both self-reported measures. Except among those with severe disease, children and adults with haemophilia have HRQoL scores comparable with those of the healthy US population. The physical aspects of HRQoL in both adults and children with haemophilia A in the US decrease with increasing severity of illness. However, scores for mental aspects of HRQoL do not differ between severity groups. These findings are comparable with those from studies in European and Canadian haemophilia populations.
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Affiliation(s)
- J-L Poon
- University of Southern California, CA 90033, USA
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16
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Wilson SR, Rand CS, Cabana MD, Foggs MB, Halterman JS, Olson L, Vollmer WM, Wright RJ, Taggart V. Asthma outcomes: quality of life. J Allergy Clin Immunol 2012; 129:S88-123. [PMID: 22386511 PMCID: PMC4269375 DOI: 10.1016/j.jaci.2011.12.988] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 12/23/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND "Asthma-related quality of life" (QOL) refers to the perceived impact that asthma has on the patient's QOL. OBJECTIVE National Institutes of Health institutes and other federal agencies convened an expert group to recommend standardized measures of the impact of asthma on QOL for use in future asthma clinical research. METHODS We reviewed published documentation regarding the development and psychometric evaluation; clinical research use since 2000; and extent to which the content of each existing QOL instrument provides a unique, reliable, and valid assessment of the intended construct. We classified instruments as core (required in future studies), supplemental (used according to the study's aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011. RESULTS Eleven instruments for adults and 6 for children were identified for review. None qualified as core instruments because they predominantly measured indicators of asthma control (symptoms and/or functional status); failed to provide a distinct, reliable score measuring all key dimensions of the intended construct; and/or lacked adequate psychometric data. CONCLUSIONS In the absence of existing instruments that meet the stated criteria, currently available instruments are classified as either supplemental or emerging. Research is strongly recommended to develop and evaluate instruments that provide a distinct, reliable measure of the patient's perception of the impact of asthma on all of the key dimensions of QOL, an important outcome that is not captured in other outcome measures.
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Affiliation(s)
- Sandra R Wilson
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
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17
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Schatz M, Zeiger RS, Yang SJ, Chen W, Crawford W, Sajjan S, Allen-Ramey F. The Relationship of Asthma Impairment Determined by Psychometric Tools to Future Asthma Exacerbations. Chest 2012; 141:66-72. [DOI: 10.1378/chest.11-0574] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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18
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Cavrini G, Broccoli S, Puccini A, Zoli M. EQ-5D as a predictor of mortality and hospitalization in elderly people. Qual Life Res 2011; 21:269-80. [DOI: 10.1007/s11136-011-9937-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2011] [Indexed: 11/28/2022]
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19
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Rubin AS, Cardoso PFG. Bronchial thermoplasty in asthma. J Bras Pneumol 2011; 36:506-12. [PMID: 20835600 DOI: 10.1590/s1806-37132010000400018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/10/2010] [Indexed: 11/22/2022] Open
Abstract
Currently available treatments for asthma provide satisfactory control of the disease in most cases. However, a significant number of patients do not respond to such treatments (i.e., do not achieve effective symptom relief). One novel approach to treating asthma is bronchial thermoplasty, in which the airway smooth muscle is specifically and directly treated. This procedure delivers radiofrequency energy to the airways in order to reduce smooth muscle-mediated bronchoconstriction. In this article, we present the thermoplasty technique, summarizing the results of the major randomized clinical trials of the procedure, as well as discussing its mechanisms of action and potential adverse effects. We also propose strategies for the future clinical use of this new treatment.
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Affiliation(s)
- Adalberto Sperb Rubin
- Pulmonary Function Laboratory, Pereira Filho Ward, Santa Casa Hospital Complex in Porto Alegre, Porto Alegre, Brazil.
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20
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Abstract
Addressing asthma from a public health perspective is a relatively new concept for which the literature provides little guidance. A public health approach seeks to decrease the burden of asthma and improve health outcomes at the population level, such as communities, cities, or states, by reaching large numbers of individuals with effective interventions and at reasonable cost. Projects designed to achieve a measureable impact at the population level are fundamentally different from projects or interventions designed to improve outcomes among individuals. This paper uses the experience of the Controlling Asthma in American Cities Project and a review of the relevant literature to explore some of the unique questions and considerations that are implicit when planning large-scale asthma projects intended to improve population outcomes. The paper is intended to inform decision making by local and state government agencies, managed care organizations, health systems, community coalitions, and funders. Analysis of asthma and other chronic disease projects aiming to achieve population-level impact is an area for continued public health research.
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Affiliation(s)
- Adam Davis
- American Lung Association in California, Oakland, CA, USA.
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21
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Guilbert TW, Garris C, Jhingran P, Bonafede M, Tomaszewski KJ, Bonus T, Hahn RM, Schatz M. Asthma that is not well-controlled is associated with increased healthcare utilization and decreased quality of life. J Asthma 2010; 48:126-32. [PMID: 21128880 DOI: 10.3109/02770903.2010.535879] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Relationships of asthma control to other asthma outcomes have been incompletely documented. OBJECTIVE This study examined the relationship between asthma control and health-related quality of life (HRQL) and subsequent healthcare resource utilization. METHODS A 1-year online prospective longitudinal survey was conducted in 497 adults and 170 children with asthma treated in the past year. Control was measured by Asthma Control Test™ (ACT) and Childhood ACT™ (C-ACT)™ scores dichotomized into "well-controlled" (scores >19) or "not well-controlled" (scores ≤19), and HRQL was measured using the PedsQL™ 3.0 Asthma Module (children) and the SF-12 Health Survey (adults). Multivariate models were used for analysis. RESULTS HRQL scores were significantly lower for adults (mean decrease 3.4) and children (mean decrease 12.8) whose asthma was not well-controlled compared to patients with well-controlled asthma. Adults with asthma that was not well-controlled at baseline had a threefold greater risk of an asthma-related doctor visit and a 10-fold greater risk of an emergency department (ED) visit for asthma in the subsequent 9 months (odds ratio (OR) = 3.3 and OR = 11.3, respectively). Children with asthma that was not well-controlled had a nearly fivefold increased risk for subsequent asthma-related doctors' and ED visits (OR = 4.8 and OR = 4.9, respectively). CONCLUSION Both adults and children with not well-controlled asthma had significantly lower quality of life and were more likely to require an office or ED visit for asthma compared to patients with higher ACT scores. Therefore, it is important to continually assess asthma control and adjust controller therapy accordingly.
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Affiliation(s)
- Theresa W Guilbert
- The Department of Pediatrics, University of Wisconsin, Madison, WI 53716, USA.
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22
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Cardarelli WJ. Asthma: are we monitoring the correct measures? Popul Health Manag 2010; 12:87-94. [PMID: 19320609 DOI: 10.1089/pop.2008.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence of asthma, a common chronic inflammatory disease of the airways, has risen sharply over the past 25-30 years, with the biggest increase found in children. Currently, more than 22 million Americans have asthma. Asthma also is associated with significant morbidity and mortality worldwide. Each year, asthma is responsible for $16 billion in direct and indirect costs due to health care utilization and loss of productivity, with over 14 million missed workdays. Asthma also accounts for almost 1.8 million emergency room visits and almost 500,000 hospitalizations annually. Therefore, assessment and monitoring of disease activity is critical to improve clinical and economic outcomes for patients with asthma. To help in this endeavor, practitioners and payers rely on evidence-based guidelines to classify disease severity, to guide treatment decisions, and to assess the degree of asthma control. In August 2007, the National Asthma Education and Prevention Program (NAEPP) updated its guidelines based on greater knowledge of disease pathophysiology and the development of newer therapeutic agents. This includes an increased emphasis on the need to establish disease severity, including the components of impairment and risk, as well as on the level of asthma control. Despite the availability of the NAEPP and other guidelines, asthma control often remains suboptimal. While numerous clinical and patient-reported measures are available, it is clear that the optimal monitoring schema for patients with asthma remains undefined. To clearly establish whether asthma control is attained, multiple measures are required and should include clinical and patient-reported assessments.
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Affiliation(s)
- William J Cardarelli
- Atrius Health/Harvard Vanguard Medical Associates, Watertown, Massachusetts 02472, USA.
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Iribarren C, Tolstykh IV, Miller MK, Eisner MD. Asthma and the prospective risk of anaphylactic shock and other allergy diagnoses in a large integrated health care delivery system. Ann Allergy Asthma Immunol 2010; 104:371-7. [PMID: 20486326 DOI: 10.1016/j.anai.2010.03.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association between asthma and anaphylaxis remains poorly understood. OBJECTIVE To ascertain, in a managed care organization in northern California, the association of asthma and asthma severity with future risk of anaphylactic shock and other selected allergy diagnoses. METHODS Using electronic data and validated algorithms, we assembled a cohort of 526,406 patients who met the criteria for asthma between 1996 and 2006 and a referent cohort (with no utilization for asthma) individually matched on age, sex, and race/ethnicity. In each cohort, 54% of patients were female and 55% were white; their mean (SD) age was 24 (20) years. The main outcome measures were anaphylactic shock (caused by an adverse food reaction, caused by serum, or other/idiopathic), allergic urticaria, anaphylaxis after sting(s), and angioedema. RESULTS The incidence of anaphylactic shock was 109.0 per 100,000 person-years in the asthma cohort and 19.9 per 100,000 person-years in the referent cohort. After adjustment for age, sex, race/ethnicity, comorbidities, and immunotherapy, asthma was associated with a 5.2-fold (95% confidence interval, 4.7- to 5.6-fold) increased hazard of anaphylactic shock. Asthma was also significantly associated with an increased risk of the 3 selected allergy diagnoses, with hazard ratios of 1.4 to 1.9. A significant trend by severity of asthma was apparent for food-related and other/idiopathic anaphylactic shock and for anaphylaxis after sting(s). CONCLUSIONS In this insured population, asthma was prospectively associated with increased risk of anaphylactic shock and other allergy diagnoses. However, the effect of asthma severity was not consistent across outcome measures.
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Affiliation(s)
- Carlos Iribarren
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA.
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24
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Schatz M, Dombrowski MP, Wise R, Lai Y, Landon M, Newman RB, Rouse DJ, Miodovnik M, O'Sullivan MJ, Caritis SN, Leveno KJ, Wapner RJ, Conway DL. The relationship of asthma-specific quality of life during pregnancy to subsequent asthma and perinatal morbidity. J Asthma 2010; 47:46-50. [PMID: 20100020 PMCID: PMC3249656 DOI: 10.3109/02770900903483758] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether asthma-specific quality of life during pregnancy is related to asthma exacerbations and to perinatal outcomes. METHODS This was a secondary analysis of data from a randomized controlled trial of inhaled beclomethasone versus theophylline in the treatment of moderate asthma during pregnancy. The Juniper Asthma Quality of Life Questionnaire (AQLQ) was administered to patients at enrollment. Exacerbations were defined as asthma symptoms requiring a hospitalization, unscheduled medical visit, or oral corticosteroid course. RESULTS Quality of life assessments were provided by 310 of the 385 participants who completed the study. There was more than a 25% decrease in the odds of a subsequent asthma exacerbation for every 1-point increase in AQLQ score for the overall score (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.55-0.96), emotion domain (OR 0.72, 95% CI 0.59-0.88), and symptoms domain (OR 0.73, 95% CI 0.57-0.94). These relationships were not significantly influenced by initial symptom frequency or forced expiratory volume in 1 s (FEV(1)). No significant relationships were demonstrated between enrollment AQLQ scores and preeclampsia, preterm birth, low birth weight, or small for gestational age. CONCLUSION Asthma-specific quality of life in early pregnancy is related to subsequent asthma morbidity during pregnancy but not to perinatal outcomes.
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Affiliation(s)
- Michael Schatz
- Department of Allergy at Kaiser Permanente, San Diego, California 92111, USA.
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25
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Castro M, Rubin AS, Laviolette M, Fiterman J, De Andrade Lima M, Shah PL, Fiss E, Olivenstein R, Thomson NC, Niven RM, Pavord ID, Simoff M, Duhamel DR, McEvoy C, Barbers R, Ten Hacken NHT, Wechsler ME, Holmes M, Phillips MJ, Erzurum S, Lunn W, Israel E, Jarjour N, Kraft M, Shargill NS, Quiring J, Berry SM, Cox G. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med 2009; 181:116-24. [PMID: 19815809 DOI: 10.1164/rccm.200903-0354oc] [Citation(s) in RCA: 493] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Bronchial thermoplasty (BT) is a bronchoscopic procedure in which controlled thermal energy is applied to the airway wall to decrease smooth muscle. OBJECTIVES To evaluate the effectiveness and safety of BT versus a sham procedure in subjects with severe asthma who remain symptomatic despite treatment with high-dose inhaled corticosteroids and long-acting beta(2)-agonists. METHODS A total of 288 adult subjects (Intent-to-Treat [ITT]) randomized to BT or sham control underwent three bronchoscopy procedures. Primary outcome was the difference in Asthma Quality of Life Questionnaire (AQLQ) scores from baseline to average of 6, 9, and 12 months (integrated AQLQ). Adverse events and health care use were collected to assess safety. Statistical design and analysis of the primary endpoint was Bayesian. Target posterior probability of superiority (PPS) of BT over sham was 95%, except for the primary endpoint (96.4%). MEASUREMENTS AND MAIN RESULTS The improvement from baseline in the integrated AQLQ score was superior in the BT group compared with sham (BT, 1.35 +/- 1.10; sham, 1.16 +/- 1.23 [PPS, 96.0% ITT and 97.9% per protocol]). Seventy-nine percent of BT and 64% of sham subjects achieved changes in AQLQ of 0.5 or greater (PPS, 99.6%). Six percent more BT subjects were hospitalized in the treatment period (up to 6 wk after BT). In the posttreatment period (6-52 wk after BT), the BT group experienced fewer severe exacerbations, emergency department (ED) visits, and days missed from work/school compared with the sham group (PPS, 95.5, 99.9, and 99.3%, respectively). CONCLUSIONS BT in subjects with severe asthma improves asthma-specific quality of life with a reduction in severe exacerbations and healthcare use in the posttreatment period. Clinical trial registered with www.clinialtrials.gov (NCT00231114).
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Affiliation(s)
- Mario Castro
- Washington University School of Medicine, Campus Box 8052, 660 S. Euclid, St. Louis, MO 63110-1093, USA.
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Dogra S, Baker J, Ardern CI. The role of physical activity and body mass index in the health care use of adults with asthma. Ann Allergy Asthma Immunol 2009; 102:462-8. [PMID: 19558003 DOI: 10.1016/s1081-1206(10)60118-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health care use in patients with asthma is affected by many factors, including sex and ethnicity. The role of physical activity (PA) and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) in this relationship is unknown. OBJECTIVE To determine the role of PA and BMI in the health care use of patients with asthma. METHODS A sample of adults with asthma (n=6,835) and without asthma (n=78,051) from cycle 3.1 of the Canadian Community Health Survey was identified. Health care use was self-reported as overnight hospital stays (yes or no), length of overnight hospital stay (<4 or > or =4 nights), and physician consultations (<3 or > or =3). Self-reported physical activities were used to derive total energy expenditure and to classify participants as active (>3.0 kcal/kg of body weight per day), moderately active (1.5-3.0 kcal/kg of body weight per day), and inactive (<1.5 kcal/kg of body weight per day). The BMI was categorized as normal weight (18.5-24.9), overweight (25.0-29.9), and obese (30.0-59.9). RESULTS Adjusted logistic regression models revealed that patients with asthma were more likely to have an overnight hospital stay (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.95-2.60), 4 or more overnight hospital stays (OR, 1.48; 95% CI, 1.12-1.96), and 3 or more physician consultations (OR, 2.43; 95% CI, 2.18-2.71) compared with patients without asthma (OR, 1.00). Inactive patients with asthma were more likely to have an overnight hospital stay (OR, 1.68; 95% CI, 1.31-2.16) and 3 or more physician consultations (OR, 1.23; 95% CI, 1.04-1.46) than active patients with asthma (OR, 1.00). Inactive/obese patients with asthma were 2.35 (95% CI, 1.69-3.27) times more likely to have an overnight hospital stay and 2.76 (95% CI, 2.11-3.60) times more likely to have 3 or more physician consultations than active/normal weight patients with asthma (OR, 1.00). CONCLUSIONS Higher PA levels are associated with lower health care use in individuals with and without asthma. In those with asthma, PA was a more important factor in overnight hospital stays than BMI, whereas both BMI and PA were important determinants of physician consultations.
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Affiliation(s)
- Shilpa Dogra
- Lifespan Health and Performance Laboratory, York University, Toronto, Ontario, Canada.
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Temprano J, Mannino DM. The effect of sex on asthma control from the National Asthma Survey. J Allergy Clin Immunol 2009; 123:854-60. [PMID: 19181370 DOI: 10.1016/j.jaci.2008.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 12/04/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have demonstrated conflicting results with regard to differences in asthma control between the sexes. OBJECTIVE We sought to identify sex differences in short-term and long-term measures of asthma control in adults from the National Asthma Survey. METHODS This study analyzed data from the National Asthma Survey (Four-State sample) sponsored by the National Center for Environmental Health, Centers for Disease Control and Prevention. Asthma control was compared between the sexes based on short-term (recent symptoms, asthma attacks, and albuterol use) and long-term (asthma attacks, work days lost, and urgent-care visits and hospitalizations in the prior year) measures. Composite scores for short-term and long-term control were calculated based on any single measure of poor asthma control and based on a sum of poor asthma control measures. RESULTS Women were more likely to have poor short-term asthma control based on any measure (adjusted odds ratio [OR], 1.20; CI, 1.01-1.44) or sum of measures (adjusted OR, 1.24; CI, 1.08-1.53) compared with men. Women also demonstrated worse asthma control based on any uncontrolled long-term measure (adjusted OR, 1.52; CI, 1.29-1.79) or sum of measures (adjusted OR, 1.68; CI, 1.45-1.93). These findings were present despite higher reported inhaled corticosteroid use and scheduled health care visits for asthma among women. CONCLUSIONS Women demonstrated worse asthma control compared with men with regard to several short-term and long-term measures, despite reporting higher rates of inhaled corticosteroid use and routine asthma care visits. Further studies are needed to elucidate whether these findings are due to differences in health reporting or to pathophysiologic differences in asthma between the sexes.
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Affiliation(s)
- James Temprano
- Department of Internal Medicine, Division of Allergy and Immunology, University of Kentucky, Lexington, KY 40508, USA.
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The effects of barriers on Health Related Quality of Life (HRQL) and compliance in adult asthmatics who are followed in an urban community health care facility. J Community Health 2009; 33:374-83. [PMID: 18581218 DOI: 10.1007/s10900-008-9108-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This cross sectional descriptive study sought to identify perceived barriers to follow-up care for adult asthmatics who are followed in two community health care facilities. A second purpose of the study was to determine the effect of any barriers to Health Related Quality of Life (HRQL) and compliance in the sample. Thirty-four adults completed a demographic and health status survey, the MiniAQLQ and the EWash Access to Health Care Survey. "Long waiting time in provider's office," "someone had to miss work," "cost of care too much, "and "long wait for an appointment" were the most prevalent perceived barriers in the sample. "Lack of transportation" was significantly associated with study participants who receive health care at one site or who stated the emergency room as their usual place of care. "Someone had to miss work" was significantly correlated with the following variables: employment, a higher annual household income, 1-2 daily medications for asthma, no overnight hospitalizations for asthma and no psychological co-morbidities. A higher reported HQOL was significantly correlated with study participants whose medical care needs were met and found access to local health care services. The only perceived barrier that was significantly correlated with compliance was study participants who "sometimes" had to reschedule an appointment with a health care provider due to "lack of transportation." The present study suggests that strategies designed to decrease the perceived barriers might improve compliance with the treatment regime, thus decreasing costs, absenteeism, and lack of continuity.
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Health-related quality of life predicts onset of asthma in a longitudinal population study. Respir Med 2008; 103:194-200. [PMID: 19046862 DOI: 10.1016/j.rmed.2008.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 08/29/2008] [Accepted: 09/14/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) has been increasingly used as an outcome measure in asthma, but less is known about the prognostic implication of low health-related quality of life. The purpose of this study was to investigate if a set of quality of life measures could predict onset of asthma. METHODS In the baseline study 391 subjects without asthma answered a respiratory questionnaire and the Gothenburg Quality of Life (GQL) instrument in 1990. The GQL questionnaire included two parts: (1) the prevalence of HRQL-related symptoms and (2) well-being scores for physical, mental and social dimensions. The participants were also investigated with spirometry and allergy testing. In 2003, the same respiratory questionnaire that had been used in 1990 was sent. There were 290 responders, of whom 22 subjects had developed asthma. RESULTS Participants who had developed asthma by the follow-up had a higher prevalence of sleep disturbances (30% vs. 10%), problems with chest pain (16% vs. 2%), depression (40% vs. 20%) difficulty relaxing (40% vs. 13%) and constipation (25% vs. 2%) at baseline than participants who did not develop asthma (p<0.05). Subjects who developed asthma also scored significantly lower on well-being variables as sleep, energy, mood, patience, memory, appetite, fitness and sense of appreciation outside home. These differences remained after adjusting for age, sex, smoking habits, asthma heredity, socioeconomic groups and building dampness. CONCLUSION Participants with low health-related quality of life at baseline were more likely to report having developed asthma 12 years later.
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Díez JDM, Barcina C, Muñoz M, Leal M. Control of persistent asthma in Spain: associated factors. J Asthma 2008; 45:740-6. [PMID: 18972288 DOI: 10.1080/02770900802216783] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The main objective of asthma treatment is tailored control for each patient. However, despite the excellent therapeutic arsenal currently available, many patients remain unable to achieve adequate control of this disease. OBJECTIVE The main objective this study was to evaluate the degree of control and the determinants of asthma in patients with persistent asthma in Spain in usual clinical practice. MATERIALS AND METHODS This was a cross-sectional epidemiological study. The patients enrolled were 18 years of age or over, with a 6-month history of diagnosed persistent asthma, who were followed up by primary care physicians in Spain between the months of June and December 2006. Demographic and socioeconomic data were collected, as were anthropometric data and different clinical variables. The control of asthma was evaluated using the Asthma Control Questionnaire (ACQ). RESULTS The study included 6,824 patients, of whom 306 were excluded; therefore the final number of patients analyzed was 6,518 (95.5%). According to severity, 41.4% of patients had mild persistent asthma, 51.2% had moderate persistent asthma, and the remainder severe persistent asthma. The mean score in the ACQ was 1.4 +/- 1.0, distributed as follows: in 28.4% of cases, the score was below 0.75; in 31.6%, it was between 0.75 and 1.5; and in 39.7% it was above 1.5. Multiple regression analysis showed that the factor that most affected the degree of control of the disease was classification by severity. Other associated factors were sex, race, body mass index, smoking, level of education, habitual activity, years since diagnosis of asthma, number of exacerbations and admissions to hospital during the last year, and basic treatment of the disease. CONCLUSIONS The number of patients with poorly controlled persistent asthma in Spain is high (71.6%). There are demographic, socioeconomic, anthropometric, and clinical variables that affect the level of control of this disease.
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Affiliation(s)
- Javíer de Miguel Díez
- Pulmonology Service, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
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Krouse HJ, Yarandi H, McIntosh J, Cowen C, Selim V. Assessing sleep quality and daytime wakefulness in asthma using wrist actigraphy. J Asthma 2008; 45:389-95. [PMID: 18569232 DOI: 10.1080/02770900801971800] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study evaluated the sleep/wake cycle of individuals with asthma in relation to asthma control, daytime sleepiness, and daytime activity. Ten persons with mild to moderate persistent asthma monitored their sleep quality and daytime wakefulness for 7 consecutive days using 24-hours wrist actigraphy. Degree of asthma control strongly correlated with sleep quality. Individuals whose asthma was not well controlled took longer to fall asleep, awoke more often, and spent more time awake during the night compared to those with well controlled asthma. Poor asthma control, use of rescue medications, and asthma symptoms were associated with daytime sleepiness and limitations in physical activity and emotional function. Forty percent of subjects reported clinically significant daytime sleepiness. Evaluating asthma throughout a 24-hour cycle provides valuable information on variations in the sleep/wake cycle associated with asthma control, use of rescue medications, and asthma symptoms.
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Affiliation(s)
- Helene J Krouse
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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Schatz M, Mosen DM, Kosinski M, Vollmer WM, Magid DJ, O'Connor E, Zeiger RS. The relationship between asthma-specific quality of life and asthma control. J Asthma 2007; 44:391-5. [PMID: 17613636 DOI: 10.1080/02770900701364296] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente, San Diego, CA 92111, USA.
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Firoozi F, Lemière C, Beauchesne MF, Forget A, Blais L. Development and validation of database indexes of asthma severity and control. Thorax 2007; 62:581-7. [PMID: 17287299 PMCID: PMC2117251 DOI: 10.1136/thx.2006.061572] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of administrative databases to perform epidemiological studies in asthma has increased in recent years. The absence of clinical parameters to measure the level of asthma severity and control is a major limitation of database studies. A study was undertaken to develop and validate two database indexes to measure the control and severity of asthma. METHODS Database indexes of asthma severity and control were derived from definitions in the Canadian Asthma Consensus Guidelines based on dispensed prescriptions and on medical services recorded in two large administrative databases from the Canadian province of Québec (Régie de l'Assurance Maladie du Québec (RAMQ) and MED-ECHO) over 12 months. The database indexes of asthma severity and control were validated against the pulmonary function test results of 71 patients with asthma randomly selected from two asthma clinics, and they were also applied to a cohort of patients with asthma followed up for 139 283 person-years selected from the RAMQ and MED-ECHO databases between 1 January 1997 and 31 December 2004. RESULTS According to the database indexes, 49.3%, 29.6% and 21.1% of patients recruited at the asthma clinics were found to have mild, moderate and severe asthma, respectively, while 53.5% were found to have controlled asthma. The mean predicted value of the forced expiratory volume in 1 s (FEV(1)) ranged from 89.8% for mild asthma to 61.5% for severe asthma (p<0.001), whereas the range from controlled to uncontrolled asthma was 89.5% to 67.3% (p<0.001). The ratio of the FEV(1) to the forced vital capacity (FEV(1)/FVC ratio) measured in 56 patients ranged from 75.8% for mild asthma to 61.8% for severe asthma (p = 0.030), whereas the range from controlled to uncontrolled asthma was 75.3% to 65.7% (p<0.001). CONCLUSION In the absence of clinical data, these database indexes could be used in epidemiological studies to assess the severity and control of asthma.
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Affiliation(s)
- Faranak Firoozi
- Université de Montréal, Faculté de pharmacie, CP 6128, Succursale Centre-ville, Montreal, Québec, Canada H3C 3J7
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Abstract
OBJECTIVES To summarize the outcomes used to evaluate inhaled corticosteroid intervention in terms of the Economic, Clinical, and Humanistic Outcomes (ECHO) model and to discuss the value of this more comprehensive approach in assessing therapeutic efficacy in asthma. DATA SOURCES Relevant articles were identified by a search of the PubMed database for English-language articles published from 1991 to 2006 and references identified from bibliographies of relevant articles. STUDY SELECTION The author's expert opinion was used to select studies for inclusion in this review. RESULTS Studies that assessed therapeutic effectiveness of inhaled corticosteroids in patients with asthma have traditionally focused on clinical indicators of treatment effect, including pulmonary function and symptoms. However, reliance on clinical indicators alone may not represent the full effect of the treatment on patients with asthma. The ECHO model is proposed as a more comprehensive and useful alternative to evaluate therapeutic effectiveness in patients with asthma. The model takes into account more recent concerns of patients and health care practitioners, including quality of life and treatment cost. Clinical studies using various ECHO outcomes are presented and the limitations of using individual outcomes are discussed. The Pediatric Asthma Episodes of Care Program, which exemplifies successful application of the ECHO model in the real-world setting, is also discussed. CONCLUSIONS The more comprehensive approach to determining therapeutic effectiveness in asthma provided by the ECHO model should enable optimization of asthma treatment, with limited health care resources.
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Affiliation(s)
- James Kemp
- Allergy and Asthma Medical Group and Research Center, San Diego, California 92123, USA.
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Schatz M, Mosen D, Kosinski M, Vollmer WM, O'Connor E, Cook EF, Zeiger RS. Validation of the asthma impact survey, a brief asthma-specific quality of life tool. Qual Life Res 2006; 16:345-55. [PMID: 17033905 DOI: 10.1007/s11136-006-9103-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Asthma Impact Survey (AIS-6) is a new six question asthma outcome tool for which information on validity has not been published. OBJECTIVE To provide validation for the AIS-6 as a brief asthma-specific quality of life tool. METHODS Surveys were sent to a random sample of members of a large managed care organization who were at least 35 years of age and in the two-year period preceding the survey had either (1) at least one documented asthma-related medical encounter, or (2) at least a 6 months supply of asthma medication dispensed. In addition to the AIS-6, the survey included a validated quality of life tool [the mini-Asthma Quality of Life Questionnaire (AQLQ)]; a validated asthma control questionnaire [the Asthma Therapy Assessment Questionnaire (ATAQ)]; a validated symptom severity scale (AOMS); and information regarding demographics, co-morbidities, asthma severity, and asthma management. The results of the AIS-6 were compared to the results of the other tools by means of correlation and factor analysis. Independent predictors of AIS-6 and AQLQ scores were determined by multiple stepwise linear regression analyses. RESULTS AIS-6 scores were significantly related to female sex, educational level, income, smoking, body mass index (BMI), COPD, steroid use, and hospitalization history in bivariate analyses. The AIS-6 score significantly correlated (r = - 0.84, p < 0.0001) with the AQLQ total score and loaded on the three factors (activity, symptoms, and concern/bother) reflected by the survey information and on which the AQLQ also loaded. Significant but somewhat smaller correlations were found between the AIS-6 and the ATAQ (r = 0.70, p < 0.0001) and the AOMS (r = 0.55, p < 0.0001). Independent predictors were the same for the AIS-6 and AQLQ and included oral steroid use, COPD history, BMI, female sex, educational level, and hospitalization in the past year. CONCLUSION These data support the validity of the short six-question AIS-6 as an asthma-specific quality of life tool.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA 92111, USA.
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Gandhi RK, Blaiss MS. What are the best estimates of pediatric asthma control? Curr Opin Allergy Clin Immunol 2006; 6:106-12. [PMID: 16520674 DOI: 10.1097/01.all.0000216853.18194.46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To evaluate asthma outcome measures in the face of the variable nature of asthma. The outcome measures are divided into objective and subjective clinical measures, humanistic measures such as quality of life, and costs of asthma control. RECENT FINDINGS Objective measures of asthma include those traditionally used such as spirometry, peak expiratory flow rate, and airway hyperresponsiveness. Recently, more attention has been geared towards markers of inflammation including exhaled nitric oxide and sputum eosinophils. Subjective measures of asthma control include patient-derived parameters such as number of wheezing episodes, nocturnal symptoms, exercise-induced symptoms, short-acting beta-agonist use, steroid bursts, emergency-department visits, and hospitalizations. Asthma-related quality of life is related to asthma morbidity, and patients with better baseline quality of life have improved outcomes. Asthma-related costs include direct costs mostly comprised of hospitalizations and emergency-room visits, and indirect costs including school absenteeism. SUMMARY There is no ideal outcome measure for evaluating pediatric asthma control, but each of these outcome measures must be used together to evaluate a patient at each outpatient visit. Patient-centered measures of asthma control must also be further incorporated into office visits for improved asthma management.
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Affiliation(s)
- Radha K Gandhi
- Department of Clinical Allergy and Immunology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Yawn BP, Yawn RA. Measuring asthma quality in primary care: can we develop better measures? Respir Med 2006; 100:26-33. [PMID: 15913975 DOI: 10.1016/j.rmed.2005.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 04/14/2005] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Barbara P Yawn
- Department of Primary Care Research, Olmsted Medical Center, 210 Ninth St. SE. Rochester, MN 55904, USA
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Abstract
Pediatric asthma is one of the most common chronic conditions seen in children throughout the world. Even with our better understanding of the pathology of pediatric asthma and improved pharmaceutical management for this disorder, we are still far from reaching the goals of optimal asthma outcomes as outlined by the National Heart, Lung, and Blood Institute of the National Institutes of Health. What we mean by outcomes is the change in the patient's current and future health due to the care given. The outcomes in pediatric asthma can be divided into three categories: clinical, humanistic, and economic. This article provides information regarding the different components of outcomes in pediatric asthma and how one can use outcomes to improve asthma control for the child.
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Affiliation(s)
- Michael S Blaiss
- Allergy and Asthma Care, 7205 Wolf River Boulevard, Germantown, TN 38138, USA.
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Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T, Koyama H, Mishima M. Longitudinal changes in patient vs. physician-based outcome measures did not significantly correlate in asthma. J Clin Epidemiol 2005; 58:532-9. [PMID: 15845341 DOI: 10.1016/j.jclinepi.2004.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Revised: 07/26/2004] [Accepted: 09/23/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Although improving health status is one important aim in managing asthmatic patients, few studies have evaluated their health status longitudinally. Therefore, we examined longitudinal changes in health status of asthma patients, and compared them with changes in physiological measures. METHODS Eighty-seven outpatients with stable asthma after 6 months of treatment were recruited. Health status using the Asthma Quality of Life Questionnaire (AQLQ) and the St. George's Respiratory Questionnaire (SGRQ), pulmonary function, peak expiratory flow (PEF) values, and airway hyperresponsiveness (AHR) were evaluated at entry and every year over a 5-year period. RESULTS Using mixed effects models to estimate the slopes, the overall AQLQ score declined statistically at a mean rate of 0.06 units/year (P=.0091). However, this decline did not reach a clinically significant level at 5 years. The total SGRQ score did not change significantly (P=.54). Although the forced expiratory volume in 1 sec declined at a mean rate of 53 mL/year, the PEF variability and AHR improved significantly. CONCLUSION Health status was clinically stable over the 5-year study period in patients with asthma, which contrasted with the changes in the physiological outcome measures. As a patient centered outcome measure, health status should be followed separately.
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Affiliation(s)
- Toru Oga
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 53 Kawahara, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Varni JW, Burwinkle TM, Lane MM. Health-related quality of life measurement in pediatric clinical practice: an appraisal and precept for future research and application. Health Qual Life Outcomes 2005; 3:34. [PMID: 15904527 PMCID: PMC1156928 DOI: 10.1186/1477-7525-3-34] [Citation(s) in RCA: 305] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 05/16/2005] [Indexed: 11/10/2022] Open
Abstract
Health-related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. HRQOL measures are also increasingly proposed for use in clinical practice settings to inform treatment decisions. In settings where HRQOL measures have been utilized with adults, physicians report such measures as useful, some physicians alter their treatment based on patient reports on such instruments, and patients themselves generally feel the instruments to be helpful. However, there is a dearth of studies evaluating the clinical utility of HRQOL measurement in pediatric clinical practice. This paper provides an updated review of the literature and proposes a precept governing the application of pediatric HRQOL measurement in pediatric clinical practice. Utilizing HRQOL measurement in pediatric healthcare settings can facilitate patient-physician communication, improve patient/parent satisfaction, identify hidden morbidities, and assist in clinical decision-making. Demonstrating the utility of pediatric HRQOL measurement in identifying children with the greatest needs, while simultaneously demonstrating the cost advantages of providing timely, targeted interventions to address those needs, may ultimately provide the driving force for incorporating HRQOL measurement in pediatric clinical practice.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX 77843-3137 USA
| | - Tasha M Burwinkle
- Department of Anesthesiology, University of Washington, 1945 NE Pacific Street, Seattle, WA 98195 USA
| | - Mariella M Lane
- Department of Psychology, College of Liberal Arts, Texas A&M University, College Station, TX 77843 USA
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Mehlhop PD, Blake K. Impact of inadequately controlled asthma: a need for targeted therapy? J Clin Pharm Ther 2005; 29:189-94. [PMID: 15153080 DOI: 10.1111/j.1365-2710.2004.00554.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P D Mehlhop
- Brody School of Medicine, East Carolina University, 2495 Henby Lane, Greenville, NC 27834, USA.
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Duong DV, Binns CW, Lee AH. Utilization of delivery services at the primary health care level in rural Vietnam. Soc Sci Med 2004; 59:2585-95. [PMID: 15474211 DOI: 10.1016/j.socscimed.2004.04.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study is to investigate factors that influence the utilization of delivery services at the primary health care level in rural Vietnam. A quantitative survey was conducted amongst 200 women who had given birth within the past 3 months. Focus group discussions and in-depth-interviews were then undertaken using the attitudes--social influence--self-efficacy model to obtain complementary information on the delivery decision. The results show that client-perceived quality of services and socio-cultural and economic factors, rather than geographical access, can affect the utilization of delivery services. It is therefore important to improve the cost-efficiency of the health care network, and delivery services should be provided in a client-oriented manner taking into account economic, social and cultural factors.
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Affiliation(s)
- Dat V Duong
- Program for Appropriate Technology in Health, 5th Floor, 57 Quang Trung Street, Hanoi, Viet Nam.
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Magid DJ, Houry D, Ellis J, Lyons E, Rumsfeld JS. Health-related quality of life predicts emergency department utilization for patients with asthma. Ann Emerg Med 2004; 43:551-7. [PMID: 15111913 DOI: 10.1016/j.annemergmed.2003.11.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE The objective of this study is to evaluate health-related quality of life as a risk factor for subsequent emergency department (ED) utilization in a cohort of patients with asthma. METHODS We conducted a 1-year prospective cohort study of 1,406 adult asthma patients. Baseline physical and mental health status were measured using the Physical Component Summary and Mental Component Summary scores from the Short Form-12 health status survey. Asthma-specific health-related quality of life was measured with the mini-Asthma Quality of Life Questionnaire. Multivariable regression was used to assess the independent association between baseline Physical Component Summary, Mental Component Summary, and Asthma Quality of Life Questionnaire scores and asthma-related ED visits during the subsequent year. RESULTS During the 1-year follow-up period, 116 patients made at least 1 asthma-related ED visit. After adjustment for multiple sociodemographic and clinical factors, both the Physical Component Summary score (odds ratio [OR] 1.72; 95% confidence interval [CI] 1.46 to 2.02) and the Asthma Quality of Life Questionnaire score (OR 1.34; 95% CI 1.18 to 1.52) were associated with subsequent asthma-related ED utilization. In contrast, overall mental health status was not associated with subsequent asthma-related ED utilization (OR 1.17; 95% CI 0.96 to 1.44). CONCLUSION Overall physical health status and asthma-specific quality of life predict subsequent ED utilization. Health-related quality of life may be useful in identifying patients at increased risk for asthma exacerbation requiring emergency care.
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Affiliation(s)
- David J Magid
- Clinical Research Unit, Colorado Permanente Medical Group, Denver, CO, USA
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Butz AM, Riekert KA, Eggleston P, Winkelstein M, Thompson RE, Rand C. Factors associated with preventive asthma care in inner-city children. Clin Pediatr (Phila) 2004; 43:709-19. [PMID: 15494877 DOI: 10.1177/000992280404300804] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this cross-sectional study was to determine if the caregiver's quality of life was associated with the child receiving appropriate preventive asthma care (2 or more preventive asthma care visits per year) in a sample of inner-city children with moderate to severe persistent asthma. Our findings confirm that children with moderate to severe persistent asthma are not receiving adequate preventive asthma care despite experiencing frequent asthma symptoms. Having a recent emergency department (ED) visit and increased number of school absences due to asthma were the strongest factors associated with these children receiving guideline-based preventive asthma care. However, for a subgroup of children without recent ED care, we found that low caregiver education level, increased school absences, and decreased caregiver's quality of life, albeit a trend, were associated with the child's receiving adequate preventive asthma care. This suggests that in a subgroup of children receiving adequate preventive care, other issues beyond basic asthma management may need to be addressed.
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Affiliation(s)
- Arlene M Butz
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21287, USA
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