Qualidade de vida na asma pediátrica: revisão da literatura

Relationship between anxiety symptoms, clinical control and quality of life of children with asthma: A cross-sectional study

OBJECTIVE

To investigate the relationship between anxiety symptoms and factors related to clinical control and quality of life of children with asthma aged 7-12 years.

METHODS

A cross-sectional comparative study involving children recruited from a reference center for asthma treatment in the city of Natal-RN. Diagnosis, control and severity were performed following GINA recommendations (2019). Sociodemographic information and spirometry results from a bronchodilator test were collected. Modified Fisher's scale, clinical control questionnaires (c-ACT and ACT), quality of life assessment (PAQLQ) (total score and domains) and anxiety symptoms assessment (SCAS) (total score and domains) were applied.

RESULTS

The sample consisted of 42 children with asthma. Symptoms of social phobia (as identified by SCAS), and household head education were related to clinical asthma control (p = .006; R ²  = .19). Total SCAS score, guardian's education and physical activity were related to total PAQLQ (p < .0001; R ²  = .33). SCAS was related to the activity limitation domain of PAQLQ (p = .004; R ²  = .17). SCAS, gender, and physical activity were related to the PAQLQ symptoms domain (p = .003; R ²  = .32). The guardian's education, physical activity practice, and the symptoms of separation anxiety, panic attack and agoraphobia (as identified by SCAS) were related to the emotional domain of PAQLQ (p = .004; R ²  = .45).

CONCLUSION

The present study shows evidence of an association between anxiety symptoms, poorer clinical control, and health-related quality of life in children with asthma.

Association between quality of life, severity of asthma, sleep disorders and exercise capacity in children with asthma: a cross-sectional study

OBJECTIVE

To assess the association between quality of life, asthma severity, sleep disorders and exercise capacity in children with asthma.

METHODS

We evaluated 45 children with asthma of both sexes aged between 7 and 12 years, diagnosed by a pediatrician/pulmonologist and classified according to the IV Brazilian Guidelines for Asthma Management: severity (intermittent/mild and moderate/severe) and control (controlled, partially controlled and uncontrolled). Quality of life (QoL), presence of sleep disorders and exercise capacity were respectively assessed using the following instruments: Pediatric Asthma Quality of Life Questionnaire (PAQLQ); Sleep Disturbance Scale for Children (SDSC); and six-minute step test (6MST).

RESULTS

Intermittent/mild and moderate/severe asthma were observed in 51.1% and 48.9% of the children evaluated, respectively. Only 8.89% of the sample had uncontrolled asthma. In the regression model, a better QoL was observed in children with lower asthma severity, lower SDSC total score and lower levels of dyspnea induced by the 6MST (β=-0.395, p=0.003; β=-0.338, p=0.011; β=-0.352, p=0.008; respectively). These factors explained 31% of the PAQLQ total score variation. Other variables (such as cardiorespiratory variables, spirometry, asthma control and number of steps in 6MST) did not predict quality of life.

CONCLUSIONS

Lower asthma severity (intermittent/mild), fewer symptoms of sleep disorder, and lower exercise-induced dyspnea predicts better quality of life in children with asthma.

Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

OBJECTIVE:

To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents.

METHODS:

We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life.

RESULTS:

The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups.

CONCLUSIONS:

Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.

Comparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy children

OBJECTIVE

to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables.

METHODS

this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%.

RESULTS

40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3±2.1 years, mean height was 1.5±0.1 m, and mean weight was 40.8±12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9%±19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r=0.373, p=0.018) and negative correlation with cardiac rate at the end of the test (r=-0.518, p<0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r=-0.311, p=0.051).

CONCLUSIONS

asthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.