Abstract
Managing pediatric asthma includes optimizing both asthma control and asthma-specific quality of life (QoL). However, it is unclear to what extent asthma-specific QoL is related to asthma control or other clinical characteristics over time. The aims of this study were to assess in children longitudinally: (1) the association between asthma control and asthma-specific QoL and (2) the relationship between clinical characteristics and asthma-specific QoL. In a 12-month prospective study, asthma-specific QoL, asthma control, dynamic lung function indices, fractional exhaled nitric oxide, the occurrence of exacerbations, and the use of rescue medication were assessed every 2 months. Associations between the clinical characteristics and asthma-specific QoL were analyzed using linear mixed models. At baseline, the QoL symptom score was worse in children with asthma and concomitant chronic rhinitis compared to asthmatic children without chronic rhinitis. An improvement of asthma control was longitudinally associated with an increase in asthma-specific QoL (p-value < 0.01). An increased use of β2-agonists, the occurrence of wheezing episodes in the year before the study, the occurrence of an asthma exacerbation in the 2 months prior to a clinical visit, and a deterioration of lung function correlated significantly with a decrease in the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) total score (p-values ≤ 0.01). Chronic rhinitis did not correlate with changes in the PAQLQ score over 1 year. The conclusion was that asthma control and asthma-specific QoL were longitudinally associated, but were not mutually interchangeable. The presence of chronic rhinitis at baseline did influence QoL symptom scores. β2-agonist use and exacerbations before and during the study were inversely related to the asthma-specific QoL over time.
Highlights
Respiratory symptoms have a significant influence on the daily life of children with asthma [1,2]
As asthma is a chronic disease, it is relevant to know whether changes in the quality of life over the course of time are correlated with changes in the asthma control
All children met the Global Initiative for Asthma (GINA) criteria and the following criteria of the Dutch Society of Pediatrics for an asthma diagnosis: (1) recurrent episodes of wheezing, coughing, breathlessness, or chest tightness [3,5]; (2) reversibility to a bronchodilator defined as an increase in the forced expiratory volume in 1 s (FEV1) of ≥ 9% of the predicted value [5,15]; and/or (3) bronchial hyperresponsiveness to histamine defined as a 20% drop in the FEV1 after inhalation of histamine ≤ 8 mg/mL [5]
Summary
Respiratory symptoms have a significant influence on the daily life of children with asthma [1,2]. In the management of asthma, monitoring of both the asthma control and the quality of life (QoL) is important. International guidelines mention optimal QoL as an important objective in asthma management, but offer no guidance on how or when to base clinical decisions on asthma-specific QoL [3,4,5]. As guidelines recommend medication titration predominantly based on asthma control, additional knowledge about the longitudinal relationship between pediatric asthma control and asthma-specific QoL is important [3,4,5]. Studies focusing on asthma-specific QoL found a fair to good cross-sectional association between the QoL and the asthma level of disease control in children [1,6,7,8,9,10,11,12]. Longitudinal data on this topic are lacking [1,6,7,8,9,10,11,12,13]
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