Abstract
Allergic asthma is a chronic inflammatory disorder associated with elevated levels of immunoglobulin E (IgE), serum eosinophilic cationic protein (S-ECP), plasma eosinophil-derived neurotoxin (P-EDN) and fraction of exhaled nitric oxide (FENO). Poor self-rated health and sickness behaviour has repeatedly been associated with inflammatory markers, but the nature of this relationship in chronic inflammatory disease is not known. Likewise, such findings largely rely on cross-sectional investigations. Self-rated health (How would you rate your general state of health?), sickness behaviour (mean rating of satisfaction with energy, sleep, fitness, appetite and memory), IgE, S-ECP, P-EDN, and FENO were assessed in 181 non-smoking primary care patients with asthma in a 1-year longitudinal study. Associations between repeated measurements were calculated using mixed regression models and Spearman’s correlations for change scores. Poor self-rated health was associated with high levels of seasonal IgE (p = 0.05) and food IgE (p = 0.04), but not total IgE or inflammatory markers. An increase over 1 year in perennial IgE was associated with a worsening of self-rated health (ρ = 0.16, p = 0.04). Poor self-rated health was associated with more pronounced sickness behaviour (p < 0.001), and a worsening in sickness behaviour was associated with a worsening of self-rated health over time (ρ = 0.21, p = 0.007). The study corroborates the importance of sickness behaviour as a determinant of self-rated health by showing that these factors co-vary over a 1-year period in a group of patients with allergic asthma. The importance of specific IgE for perceived health in primary care patients with mild to moderate asthma needs further investigation.
Highlights
Health care use of patient-reported outcomes, directly reported by the patient without interpretation of the response by a clinician or anyone else,[1] has been related to increased cost-effectiveness and improved survival.[1,2] In asthma, patient-reported outcomes have potential in assessing the impact of the disease and its treatment on health-related outcomes from the perspective of the patient.[3]a better understanding of determinants of central patient-reported outcomes in asthma, such as ratings of overall health, is warranted
We investigated sickness behaviour and asthma-specific inflammatory markers, i.e., fraction of exhaled nitric oxide (FENO), immunoglobulin E (IgE), serum eosinophilic cationic protein (S-eosinophil cationic protein (ECP)) and plasma eosinophil-derived neurotoxin (P-eosinophil-derived neurotoxin (EDN)), as and poor self-rated health was not attenuated by including corticosteroid dose or treatment with leukotriene-receptor antagonist (LTRA) in the analysis
Higher levels of P-EDN was associated with low energy in both men and women (b: 0.22, 95% CI 0.07; 0.39, p = 0.005)
Summary
Health care use of patient-reported outcomes, directly reported by the patient without interpretation of the response by a clinician or anyone else,[1] has been related to increased cost-effectiveness and improved survival.[1,2] In asthma, patient-reported outcomes have potential in assessing the impact of the disease and its treatment on health-related outcomes from the perspective of the patient.[3]. We have previously reported that persons with a diagnosis of asthma report worse self-rated health than persons without asthma.[22] In addition, patients with asthma often suffer from comorbid problems such as fatigue[23] or psychiatric symptoms.[19] It has not yet been studied if either local or systemic and women, independent of age and BMI, but not with perennial allergic inflammation in chronic asthma is associated with poor IgE or total IgE levels (Table 2). Poor self-rated health was significantly associated with higher determinants for self-rated health in primary care patients with values for the sickness behaviour composite variable in both men chronic allergic asthma followed over 12 months. We hypothesized that changes in levels of inflammatory markers and sickness behaviour would be mirrored in corresponding changes in self-rated health
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