Abstract
BackgroundThe aim was to evaluate the impact of asthma on patients’ Health-Related Quality of Life (HRQoL) by comparing asthmatic women and men with reference norms, to examine the factors which contributed to an impaired HRQoL, and to identify groups at higher risk.MethodsCross-sectional evaluation of 222 primary care patients with persistent asthma (18–40 years old). HRQoL impact was estimated with the EuroQol-5 Dimensions (EQ-5D), which allows calculating Quality-Adjusted Life-Years (QALYs) by applying society preferences. Participants self-completed the EQ-5D questionnaire online. Telephonic interviews collected information on medication and adherence, and administered the Asthma Control Questionnaire. Severity markers included asthma-related comorbidity, previous oral corticosteroids course prescription, and inhaled corticosteroids daily dose. After bivariate analyses, multiple linear regression models were constructed to examine the relations between HRQoL asthma impact and socio-demographic and clinical variables, using as dependent variable the deviation from general population-based EQ-5D reference norms.ResultsDeviation from the EQ-5D index norms was moderate in most age/gender groups (-0.1, which corresponds to 0.6 standard deviations), while it was large in women aged 18–24 years (-0.18, corresponding to 1.1 standard deviations). In regression models, a poor asthma control was the only factor independently associated to HRQoL impact in both women and men: β -0.18 (p<0.001) and -0.15 (p = 0.01) respectively. Translating these β coefficients to QALYs, they are interpretable as 66 fewer days of full health per year in women with uncontrolled asthma and 55 for men, compared with those with controlled asthma.ConclusionPersistent asthma has a moderately negative HRQoL impact on patients of both genders, and the youngest women have been identified as a high risk group which merits further research. We identified asthma control as the major contributor to impaired HRQoL in patients, regardless of their gender, suggesting that asthma HRQoL impact could be alleviated by achieving a good control of symptoms.
Highlights
International guidelines for asthma have emphasized the need to include patients HealthRelated Quality of Life (HRQoL) [1] improvement in treatment goals
Deviation from the EuroQol-5 Dimensions (EQ-5D) index norms was moderate in most age/gender groups (-0.1, which corresponds to 0.6 standard deviations), while it was large in women aged 18–24 years (-0.18, corresponding to 1.1 standard deviations)
A poor asthma control was the only factor independently associated to Health-Related Quality of Life (HRQoL) impact in both
Summary
International guidelines for asthma have emphasized the need to include patients HealthRelated Quality of Life (HRQoL) [1] improvement in treatment goals. Clinical studies offer limited information on this topic because they lack a comparison with the general population, where women were found to have worse HRQoL than men [6,7,8] To answer this question, we need to know how far the HRQoL of asthma patients is from the general population, by comparing them with controls or reference norms. The instruments used to assess HRQoL can be roughly divided into disease-specific and generic ones [9] While the former are very useful, they do not usually allow the evaluation of asthma impact in comparison with that of other diseases or with the general population. Reference norms have been mainly developed to interpret generic HRQoL questionnaires, permitting comparisons of a disease-specific sample with counterparts from the general population. The aim was to evaluate the impact of asthma on patients’ Health-Related Quality of Life (HRQoL) by comparing asthmatic women and men with reference norms, to examine the factors which contributed to an impaired HRQoL, and to identify groups at higher risk
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