Asthma-specific Quality Of Life Research Articles

Quality of life and autonomy preferences in stable asthmatics: A developing country scenario

The quality of life (QOL) and autonomy preferences of asthmatics in developing countries have been sparingly researched, with a resulting lack of management strategies. This study determined the asthma-specific QOL and autonomy preferences of a population of asthmatics in a developing country and their association with relevant sociodemographic and clinical characteristics. A cross-sectional study using the Asthma Quality of Life Questionnaire and the Asthma Autonomy Questionnaire was performed on a population of stable asthmatics recruited from a tertiary care centre in India. Severity of the disease was assessed by spirometry. The study population comprised 80 asthmatics. The mean (SD) overall QOL score was 5.04 (0.97). This was significantly associated with history of hospitalization during the previous year for an asthma attack (P < 0.01) and with FEV(1) (P < 0.05) on univariate analysis; on multivariate analysis, only history of hospitalization was significant. Autonomy preferences of the patients showed higher scores for information-seeking (mean (SD) = 78.95 (16.35) ) than decision-making (mean (SD) = 38.21 (14.6)). The information-seeking preferences had a negative correlation with age (P < 0.01) and a positive correlation with education status (P < 0.01) and decision-making correlated with education status (P < 0.05). A minority of patients (19%) indicated a preference for a greater say in decision-making than their physicians. There was a lower tendency for decision-making when given a 'severe exacerbation' scenario than in 'mild exacerbation' (P < 0.001) or 'stable disease' (P < 0.001). Hospitalization history and FEV(1) values are the parameters having the most significant impact on the QOL of asthmatics. There is a clear desire to obtain more information about the disease but most patients do not endorse the idea of making independent disease-related decisions.

Asthma severity and child quality of life in pediatric asthma: A systematic review

Objective To systematically review evidence of asthma severity as a correlate of child quality of life (QOL) in pediatric asthma. Methods Online bibliographic databases (PsycINFO, PsycARTICLES, and MEDLINE) were used to identify relevant studies that specifically considered the relationship between asthma severity and child QOL. Results Fourteen studies matching inclusion and exclusion criteria were reviewed. Asthma severity was significantly related to child QOL in nine of these studies. Informant of QOL and type of QOL measure were found to influence the strength of the relationship between severity and child QOL in pediatric asthma. Conclusions Findings suggest that asthma severity is a correlate of child QOL. Children whose asthma symptoms are not well-managed are likely to experience an impaired level of QOL. Findings also suggest the need to utilize asthma-specific QOL measures and an informant of QOL other than the child's parent in order to receive the most accurate information about the child's level of functioning. Practice implications Researchers and healthcare providers basing clinical outcomes on QOL assessments should consider asthma severity in their evaluations. Further, researchers and healthcare providers should recognize the continued need to reduce asthma severity and improve asthma symptom control in their attempts to improve the QOL of children with asthma.

The impact of home cleaning on quality of life for homes with asthmatic children

Treatment with common household bleach containing hypochlorite destroys dust mites and denatures protein allergens. The purpose of this study was to determine if home use of hypochlorite products results in lowered exposure to bacteria, fungi, and protein allergens and improved quality of life (QOL) for asthmatic persons in the home. Asthmatic and nonasthmatic households containing at least three persons (between 2 and 17 years of age) were recruited. Households were supplied one of three sets of cleaning products (regular products, some containing hypochlorite; regular products plus three additional products with dilute hypochlorite; control, no products). Participants were supplied with cleaning instructions and asthma education. The control group was instructed to clean as usual. Participants completed general health and QOL questionnaires. Asthmatic participants completed an additional asthma QOL questionnaire. Families participated in the study for 8 weeks and completed the full set of questions every 2 weeks. Homes were visited at the beginning of the study and twice thereafter at monthly intervals. Samples evaluated were surface bacteria, viable and nonviable airborne spores, and dust antigen content. Reductions in surface bacteria, airborne fungal spores, and dust antigen levels were achieved. Significant improvement in general health parameters was seen for the asthmatic product groups over the control group. Significant improvement in general QOL and asthma-specific QOL was seen in the asthmatic group. Emphasis on cleaning and cleaning education combined with hypochlorite-based cleaning supplies resulted in significantly improved QOL for families with asthmatic children.

BMI and Health Status Among Adults With Asthma

A convincing body of literature links obesity with a higher risk for developing adult-onset asthma. The impact of obesity on asthma severity among adults with pre-existing asthma, however, is less clear. In a prospective cohort study of 843 adults with severe asthma, we studied the impact of BMI on asthma health status. The prevalence of obesity and overweight were 44% (95% confidence interval (CI) 41-47%) and 28% (95% CI 25-32%). The obese BMI group was associated with a higher risk for daily or near daily asthma symptoms than was the normal BMI group (odds ratio (OR) 1.81; 95% CI 1.10-2.96). Compared to the normal BMI group, generic physical health status was worse in the overweight (mean score decrement -2.42 points; 95% CI -4.39 to -0.45) and the obese groups (-6.31 points; 95% CI -8.14 to -4.49). Asthma-specific quality of life was worse in the underweight (mean score increment 8.66 points; 95% CI 2.53-14.8) and obese groups (4.51 points; 95% CI 2.21-6.81), compared to those with normal BMI. Obese persons also had a higher number of restricted activity days that past month (5.05 days; 95% CI 2.90-7.19 days). It appears that obesity has a substantive negative effect on health status among adults with asthma. Further work is needed to clarify the precise mechanisms. Clinicians should counsel dietary modification and weight loss for their overweight and obese patients with asthma.

Assessing the responsiveness of the Asthma Quality of Life Questionnaire with pharmaceutical care

To assess the responsiveness of the Asthma Quality of Life Questionnaire (AQLQ) in the context of pharmaceutical care delivery New Zealand community pharmacy setting. Community pharmacy practices in three locations in the Otago and Southland region of New Zealand. About 62 patients with asthma (17-80 years of age) were recruited in five community pharmacies in the Otago and the Southland region of New Zealand. Patients were randomly assigned to two groups (Group 1 and Group 2). The AQLQ and a study-specific outcomes questionnaire were administered to both groups at baseline (T1), then again (with an additional global Self-Assessment of change question) 3 months later (at T2) after providing the service to Group 1. Responsiveness of the AQLQ was assessed by measuring the ability of the AQLQ to detect within-subject change in patients who subjectively indicated change, and to distinguish between two groups of patients: those who indicated change and those who indicated no change. Additionally, the correlation between the change of the AQLQ scores at T2 and the patients' self-assessment of change at T2 was estimated and used as means for assessing the AQLQ responsiveness. Asthma-specific quality of life as measured by the AQLQ and change in quality of life as perceived by participants. The results supported the responsiveness of three out of the four domains of the Asthma Quality of Life Questionnaire. The fourth domain, Environmental stimuli, showed weaker responsiveness, and the reasons of this were discussed. This study provided data supporting the responsiveness of the AQLQ when used in the context of pharmaceutical care. However, while the AQLQ's Activity Limitation, Symptoms and Emotional domains reflected adequate sensitivity to change in QoL over time, its Environmental domain was less sensitive. Researchers conducting longitudinal studies utilising the AQLQ in pharmaceutical care interventions should bear this in mind, and should consider the possible reasons for this apparent lack of responsiveness, and its implications.

Quantifying asthma symptoms in adults: The Lara Asthma Symptom Scale

Accurate assessment of asthma symptoms is critical in research and clinical settings. A multidimensional asthma control questionnaire could provide more accurate information about asthma symptoms than global assessments, which often overestimate asthma control. We sought to evaluate the efficacy of the Lara Asthma Symptom Scale (LASS) in adults with persistent asthma. Participants were 18 to 64 years of age with persistent asthma. Data were collected at baseline, 6 months, and 12 months. We described the construct and predictive validity of the LASS by comparing it with measures of pulmonary function (FEV(1)), asthma-specific quality of life (Juniper's Asthma Quality of Life Questionnaire [AQLQ]), and health care use (emergency department [ED] visits and hospitalizations). Three hundred eighty-three participants provided baseline data. The LASS had high internal consistency reliability (Cronbach alpha = .84). LASS scores correlated significantly with baseline measures of FEV(1) (-0.20, P = .0002), AQLQ (-0.68, P < .0001), ED visits (0.17, P = .002), and hospitalizations (0.15, P = .008). Baseline LASS scores were associated significantly with ED visits (P = .03) and hospitalizations (P = .04) over the subsequent 12 months. Change in LASS scores over time correlated significantly with changes in FEV(1) (-0.22, P = .001) and AQLQ (-0.70, P < .001). The LASS demonstrated good internal consistency, excellent validity based on concurrent criterion validity and longitudinal predictive validity, and good discriminatory properties in a heterogeneous sample of adults with persistent asthma. This study validates a simple multidimensional asthma questionnaire as a clinical tool in the assessment of asthma control in adults.

Development, Implementation and Evaluation of a New Adult Asthma Self-Management Program

The purpose of the research was to develop, implement, and evaluate a new adult asthma self-management program with a multidisciplinary perspective. Small groups of adults met for 2 hr for 7 consecutive weekly meetings. Participants were asked to practice asthma specific behaviors (including peak expiratory flow monitoring, avoidance/removal of asthma triggers, and controller medication adherence) and general lifestyle behaviors (including drinking water, practicing relaxation, washing hands, and exercising). Learner-centered teaching techniques such as interactive communication and social support were utilized to help participants practice self-management behaviors including problem-solving and goal-setting. Paired sample t-tests included statistically significant improvements in asthma knowledge, asthma specific quality of life (QOL), asthma specific behaviors such as peak flow monitoring and general life style behaviors such as frequency of daily exercise. These results provide evidence that this new adult asthma self-management program can lead to both knowledge acquisition and behavioral changes.

Impact of perceived neighborhood problems on change in asthma-related health outcomes between baseline and follow-up

We investigated whether perceived neighborhood problems (NP) predicted changes over a 2-year period in asthma-specific quality of life (QOL), physical functioning (PF), and depressive symptomology (DEP) in a longitudinal cohort of 340 adults with asthma. There is a threshold and plateau effect between NP and PF, such that NP do not affect changes in PF until the problems reach the level of Quartile 3. People who had NP scores in Quartile 3 had lower PF compared to people who reported NP in Quartiles 1 or 2 (mean difference −3.09). High NP also predicted over two-fold odds of high DEP (Center for Epidemiological Studies Depression [CES-D] score⩾16) at follow-up (odds ratio=2.34; 95% confidence interval: 1.09–5.00). NP did not predict decline in QOL. Analyses adjusted for demographics, asthma severity, and baseline value of the health outcome.

The role of coping strategies in quality of life of adolescents with asthma

This study aimed to determine which coping strategies are associated with better quality of life (QOL) in adolescents with asthma. Furthermore, because coping can mediate the effects of health stressors on QOL, this study also examined the indirect effect of asthma severity on QOL via coping. Between January and May 2003, 553 Dutch adolescents with asthma (aged 12–6 years) completed questionnaires assessing coping strategies, symptom severity, overall QOL and positive QOL domain (positive effects of asthma domain). The relations between symptom severity, coping strategies and QOL were tested with structural equation modelling (SEM). Symptom severity affected overall and positive QOL, both directly and indirectly via coping. The coping strategies restricted lifestyle and worrying about asthma were associated with poorer overall QOL. The use of the coping strategies restricted lifestyle, positive reappraisal, and information seeking was related to increased scores on the positive QOL domain, whereas hiding asthma was related to lower scores on the positive QOL domain. The findings of this study suggest that coping mediates the effect of symptoms of asthma on QOL among adolescents with asthma. Several suggestions for interventions to improve asthma-specific QOL are discussed.

The Relationship Between Asthma-Specific Quality of Life and Asthma Control

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.

Perceived neighborhood problems and quality of life, physical functioning, and depressive symptoms among adults with asthma.

We investigated associations between perceived neighborhood problems and quality of life (QOL), physical functioning, and depressive symptoms among adults with asthma. Using cross-sectional data from adults with asthma in northern California (n=435), we examined associations between 5 types of perceived neighborhood problems (traffic, noise, trash, smells, and fires) and asthma-specific QOL (Marks instrument), physical functioning (Short Form-12 physical component summary), and depressive symptoms (Center for Epidemiological Studies-Depression). We used multivariate regression analysis. When asthma severity and sociodemographics were taken into account, people reporting a score of 8 or higher on a scale of 0 to 25 for serious problems (the top quartile of seriousness) in their neighborhoods had significantly poorer QOL scores (mean difference=5.91; standard error [SE]=1.63), poorer physical functioning (mean difference=-3.04; SE=1.27), and almost a fivefold increase in depressive symptoms (odds ratio=4.79; 95% confidence interval=2.41, 9.52). A high level of perceived neighborhood problems was associated with poorer QOL, poorer physical functioning, and increased depressive symptoms among people with asthma when disease severity and sociodemographic factors were taken into account.

Area-level socio-economic status and health status among adults with asthma and rhinitis

Socio-economic status (SES) may affect health status in airway disease at the individual and area level. In a cohort of adults with asthma, rhinitis or both conditions, questionnaire-derived individual-level SES and principal components analysis (PCA) of census data for area-level SES factors were used. Regression analysis was utilised to study the associations among individual- and area-level SES for the following four health status measures: severity of asthma scores and the Short Form-12 Physical Component Scale (SF-12 PCS) (n = 404); asthma-specific quality of life (QoL) scores (n = 340); and forced expiratory volume in one second (FEV1) per cent predicted (n = 218). PCA yielded a two-factor solution for area-level SES. Factor 1 (lower area-level SES) was significantly associated with poorer SF-12 PCS and worse asthma QoL. These associations remained significant after adding individual-level SES. Factor 1 was also significantly associated with severity of asthma scores, but not after addition of the individual-level SES. Factor 2 (suburban area-level SES) was associated with lower FEV1 per cent predicted in combined area-level and individual SES models. In conclusion, area-level socio-economic status is linked to some, but not all, of the studied health status measures after taking into account individual-level socio-economic status.

Improved asthma outcomes from allergy specialist care: A population-based cross-sectional analysis

Prior studies suggest that allergist care improves asthma outcomes, but many of these studies have methodological shortcomings. We sought to compare patient-based and medical utilization outcomes in randomly selected asthmatic patients cared for by allergists versus primary care providers. A random sample of 3568 patients enrolled in a staff model health maintenance organization who were given diagnoses of persistent asthma completed surveys. Of these participants, 1679 (47.1%) identified a primary care provider as their regular source of asthma care, 884 (24.8%) identified an allergist, 693 (19.4%) reported no regular source of asthma care, and 195 (5.5%) identified a pulmonologist. Validated quality of life, control, severity, patient satisfaction, and self-management knowledge tools and linked administrative data that captured medication use were compared between groups, adjusting for demographics and baseline hospital and corticosteroid use. Compared with those followed by primary care providers, patients of allergists reported significantly higher (P < .001) generic physical and asthma-specific quality of life, less asthma control problems, less severe symptoms, higher satisfaction with care, and greater self-management knowledge. Patients of allergists were less likely than patients of primary care providers to require an asthma hospitalization (odds ratio, 0.45) or unscheduled visit (odds ratio, 0.71) and to overuse beta-agonists (odds ratio, 0.47) and were more likely to receive inhaled steroids (odds ratio, 1.81) during their past year. Allergist care is associated with a wide range of improved outcomes in asthmatic patients compared with care provided by primary care providers.

Community Pharmacy–Based Pharmaceutical Care for Asthma Patients

Despite significant progress in asthma drug therapy in recent years, there has been no major change in asthma morbidity and mortality. It is still important to determine whether pharmaceutical care (PC) influences health outcomes. To evaluate the effectiveness of PC with regard to clinical, humanistic, and economic outcomes in adults with asthma. An intervention study was conducted over 12 months. At baseline, 39 community/retail pharmacies, 84 primary care physicians (general practitioners, internal specialists, chest physicians), and 183 patients (aged 18-65 y) diagnosed with asthma were included. To evaluate economic outcomes, 2 German statutory health insurance funds provided 2 years of claims data for their insured patients (n = 55). A 1:10 matching was carried out to compare the data of this intervention subgroup with those of a control group (n = 550). Significant improvements were found for all humanistic outcomes (eg, asthma-specific quality of life, self-efficacy, knowledge, medication adherence). In addition, asthma severity, self-reported symptoms, peak expiratory flow, and patients' inhalation technique improved. Increases in forced expiratory volume in 1 second and vital capacity were not significant over time. Evaluation of the insurance claims data revealed a shift toward better adherence to evidence-based therapy. The study shows that PC for people with asthma has a positive impact on humanistic and, to some extent, on clinical outcomes. To determine potential economic benefits, future research should focus on patients with more severe asthma.

Symbicort in steroid-dependent asthma: reduction of oral steroids requirements

Objective: to study the ability of inhaled Symbicort to reduce daily oral steroids (OS) requirements in patients with severe steroid-dependent asthma. Methods: 16 patients with severe steroid-dependent asthma were included into the study (5 males, 11 females, mean age 53 ± 8 years, mean dose of OS 10.9 ± 5.2 mg / day, mean OS treatment duration 9.3 ± 4.1 years, mean FEV1 59.3 ± 15.1%). All patients received Symbicort administered by means of a multidose poder inhaler 4.5 / 160 mkg 2 inhalations twice daily, every 2 weeks patients underwent controlled OS reduction on the basis of predetermined asthma stability criteria. Results: OS was eliminated or reduced in 14 patients (87.5 %), the OS dose was reduced to 3.3 ± 6.8 mg / day (р &lt; 0.001). At the end of 12 weeks of Symbicort therapy FEV1 and FVC increased by 18.6 % and 8.9 %, respectively. Daytime and nighttime asthma symptom severity scores improved in average by 1 point (р &lt; 0.001). The number of inhalations of short-acting β2-agonists reduced from 3.4 ± 1.7 to 1.5 ± 1.3 puffs / day (р &lt; 0.001). Statistically and clinically significant improvements were seen in all 4 domains of quality of life scores (AQLQ) (р &lt; 0.001). The level of NOex reduced significantly form 18.6 ± 11.4 ppb at baseline to 7.9 ± 2.8 ppb after 12 weeks (р = 0.001). The side effects of OS were reduced to the end of study. Conclusion: in patients with severe steroid-dependent asthma therapy with Symbicort allows to eliminate or reduce OS therapy with improved lung function, improved daytime and nighttime asthma symptoms, improved asthma-specific quality of life, reduction of short-acting β2-agonists use and reduction of side effects of OS.

Relationship of validated psychometric tools to subsequent medical utilization for asthma

Risk stratification is used to identify patients with asthma at increased risk of experiencing morbidity and resource utilization. Validated psychometric tools are infrequently studied sources of data for this purpose. To evaluate 4 types of validated psychometric tools as predictors for subsequent asthma utilization and determine their clinical usefulness. Eleven hundred patients with active asthma from a Health Maintenance Organization completed surveys that included demographic information and validated psychometric tools measuring generic quality of life (physical and mental components), asthma-specific quality of life, asthma control, and asthma symptom severity. Survey records were linked to administrative data that captured emergency department and hospital care, short-acting beta-agonist, and oral corticosteroid utilization for the year of and the year following the survey. Relationships of survey variables with subsequent utilization were assessed, adjusting for both baseline demographic and asthma utilization factors. Scores of each psychometric tool were significantly related to subsequent utilization in univariate analyses and after adjusting for baseline utilization and demographic risk factors. Patients with higher scale-defined morbidity were as much as 4 times more likely to have subsequent utilization (sensitivity as high as 58%; specificity as high as 78%). Addition of an asthma-specific tool to either demographic or utilization prediction models added sensitivity (as much as 15%) but did not substantially improve the prediction properties of models containing both demographic and utilization predictors. Validated psychometric tools appear useful for asthma risk stratification in individuals and in populations in which both utilization and demographic predictors are not available.

Perceived Control and Quality of Life in Asthma: Impact of Asthma Education

The purpose of this study was to determine the relationship between patients' perception of asthma control and generic and asthma-specific quality of life (QOL) post-completion of a behavior modification–based adult asthma education program. A secondary objective was to examine associations between changes in perceived control of asthma and generic and asthma-specific QOL. Outcome measures were collected via an asthma management questionnaire (AMQ), generic (SF-36) and asthma-specific (AQLQ) QOL questionnaires, and a perceived control of asthma questionnaire (PCAQ). The cohort (n = 55) consisted of predominately female (75%), married (56%), middle income (46%) patients with severe asthma (65%) who had completed a university or college education (20%) and were working full-time (42%). The mean age was 45.2 (SD = 17.5) years. Perceived control of asthma and generic and asthma-specific quality of life significantly improved after completing the behavior modification–based adult asthma education program. Significant associations were found between perceived control of asthma (PCAQ) and both generic (SF-36) and asthma-specific QOL (AQLQ). Baseline PCAQ was related to all four domains and the total score of the AQLQ and 5 of the 8 domains of the SF-36. PCAQ was related to 3 of the 4 AQLQ domains at 3 months and total AQLQ score at both 1 and 3 months post-education. PCAQ was related to all 8 domains of the SF-36 at 1 month; and 4 of 8 domains at 3 months. Change in PCAQ (ΔPCAQ) was related to change in symptom score, emotional functioning, and total AQLQ score from baseline to 1 month and change in symptom score from baseline to 3 months. In conclusion, perceived control of asthma in patients participating in a behavior modification–based asthma education program was related to generic and disease-specific QOL. An improvement in PCAQ was associated with improved QOL following asthma education. Using the PCAQ as part of an asthma educational needs assessment may be a quick, simple way to identify and target education towards asthma patients with low perceived control.

Clinician-Assessed Poor Compliance Identifies Adults with Severe Asthma Who Are at Risk of Adverse Outcomes

Our aim was to determine whether clinician-identified poor compliance is useful in identifying, from among adults with severe asthma, patients with characteristics likely to put them at risk of adverse outcomes. Patients with severe asthma (previous hospital admissions and/or prescribed step 4–5 treatment according to British Thoracic Society guidelines) considered by clinicians to be either compliant (C, N = 41) or poorly compliant (PC, N = 92) with aspects of their recommended management (attendance at appointments, taking medication, and monitoring asthma) provided data on symptoms, health service use, medication, self-management practices, physical and psychological comorbidities, and sociodemographic/socioeconomic characteristics. Cross-sectional univariate analyses were used to examine whether the groups differed with respect to self-reported indicators of asthma morbidity and self-management. Logistic regressions were additionally used to explore psychosocial factors independently associated with patients being identified as PC. Compared with C patients, PC patients had significantly poorer self-reported asthma control in terms of medication use, symptoms, time off work, asthma-specific quality of life, primary care visits, emergency attendances, and hospital admissions. This was coupled with poorer self-management practices. Patients identified as PC also had higher levels of physical and psychological comorbidities, were younger, and faced more difficult social and economic circumstances. We identified significant psychological (anxiety) and social (younger age, not working, number of benefits, adverse family circumstances) factors independently associated with patients being identified as PC. Among adults with severe asthma, clinician-assessed poor compliance was useful in distinguishing between two groups that differed significantly in terms of asthma morbidity indicators, self-management practices, and psychosocial characteristics, which have been previously shown to be associated with hospital admissions, near-fatal attacks, and fatal asthma. We conclude that clinician-assessed poor compliance is a useful marker for identifying patients at risk of these adverse outcomes.

Intensive Care Unit Admission for Asthma: A Marker for Severe Disease

Background. There appears to be an asthma epidemic in the United States and other developed countries, with increasing prevalence and severity of asthma. Despite these trends, the understanding of severe asthma remains limited. Research has been hampered by the lack of clear methodology for identifying a cohort of adults with severe asthma. We systematically evaluated a method for defining a cohort of adults with severe asthma based on recent intensive care unit admissions for asthma. Methods. We used survey interview and computerized utilization data from a cohort of 400 adults with severe asthma who were enrolled after hospitalization at 17 Northern California Kaiser Permanente hospitals. To assess asthma severity, we used a multifaceted approach that combined structured telephone interview data with computerized utilization data. Using a referent group of adults who were hospitalized without intensive care unit (ICU) admission (n = 282), we examined whether ICU admission is a valid marker for severe disease (n = 118). Results. Adults with asthma who had recent ICU admission had greater severity-of-asthma scores, controlling for sociodemographic factors, smoking, and atopic history (mean score increment 2.3 points; 95% CI 1.3 to 3.2). The ICU subjects also had poorer asthma-specific quality of life (mean score increment 6.6 points; 95% CI 3.5 to 9.8) and were more likely to indicate severe self-perceived asthma (49% vs. 22%, p < 0.0001). Adults with recent ICU admission were more likely to have seen an asthma specialist during the past year (27% vs. 16%). They were also more likely to have had an asthma-related emergency department visit (37% vs. 26%), hospitalization (17% vs. 6%), and ICU admission during the previous year (5% vs. 0.7%) (p < 0.05 in all cases). Among the 311 adults with asthma who had continuous Kaiser Permanente pharmacy benefits for the previous 12 months, a greater proportion of the ICU group received inhaled corticosteroids during the 12 months prior to hospitalization (78% vs. 65%, p = 0.024). Conclusions. Admission to the ICU for asthma identifies a subgroup with severe disease, providing a valid methodology for defining a cohort of adults with severe asthma.

Emotional quality-of-life and outcomes in adolescents with asthma

Examine the association between emotional quality-of-life (QOL) and asthma morbidity in adolescents with asthma. Cross-sectional survey of 185 adolescents with asthma 11 to 17 years of age cared for in three managed care organizations (MCOs) in the United States. The asthma-specific Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and a short version of the generic Child Health and Illness Profile-Adolescent Edition (CHIP-AE) were used to assess emotional QOL. Asthma morbidity measures were: asthma control, emergency department (ED) visits, hospitalizations, doctor visits for worsening asthma, and missed school because of asthma. Of the adolescents surveyed, 45% reported feeling depressed, 41% had ED visits, and 30% missed >or=1 day of school because of asthma. Poorer asthma-specific emotional QOL was associated with poorer control of asthma symptoms ( P < .0001), missed school (OR 7.1, P < .05), and doctor visits for worsened asthma (OR = 7.0, P < .05). Emotional symptoms related to asthma are common in adolescents with persistent asthma and asthma-specific QOL is related to increased asthma morbidity, healthcare use, and school absenteeism. Adolescents with high morbidity from asthma exhibit poorer QOL. Therefore, the evaluation of asthma-specific emotional QOL should be included in the assessment of adolescents with asthma.