Asthma-specific Questionnaires Research Articles

Exploring the relationship between generalised anxiety/depression scales and asthma-specific quality of life/control questionnaires in a specialist asthma clinic

Introduction Psychological issues are common in patients with chronic disabling diseases such as asthma. National guidance recommends that specialist asthma clinic attendees should complete questionnaires screening for psychological comorbidities. However, completing these in addition to asthma specific questionnaires can be burdensome. In order to investigate whether anxiety and depression questionnaires can be used in a targeted manner, this study investigates the correlation between the respective scores. We hypothesize that there is correlation between asthma-specific and anxiety/depression questionnaire scores. Methods Three-hundred individuals with poorly controlled asthma attending a specialist clinic were asked to complete Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaires (PHQ-9). A Pearson correlation coefficient was generated and area under ROC and confusion matrices were used to assess correlation. Results 49% and 47% of patients completing the GAD-7 or PHQ-9 questionnaires, respectively had scores above the screening level for co-morbid anxiety and depression. Additional questionnaires were often incomplete (GAD-7 = 150 and PHQ-9 = 140). GAD-7 and PHQ-9 correlated with ACQ and mini-AQLQ (all p = <0.001, r values 0.53–0.65). Asthma-specific questionnaire scores were predictive of GAD-7 and PHQ-9 scores (AUCs of 0.78 to 0.84). 75% of patients with a mini-AQLQ score of <3 met the threshold GAD-7 and PHQ-9 score of 10. Conclusions ACQ and mini-AQLQ correlate with GAD-7 and PHQ-9 amongst specialist asthma clinic attendees. A mini-AQLQ >3 suggests patients are unlikely to have anxiety or depression. These findings could be used to identify patients requiring formal screening for psychological co-morbidity.

Validity of three asthma-specific quality of life questionnaires: the patients' perspective

ObjectivesIt is not known which of the many asthma-specific quality of life (QoL) questionnaires best capture the lived experience of people with asthma. The objective of this study was to...

The link between chronic rhinosinusitis and asthma: A questionnaire-based study.

Treatments for chronic rhinosinusitis (CRS) and asthma can affect both conditions, based on the united airway concept. This study aimed to evaluate the link between CRS and asthma, based on disease-specific quality of life measures.We performed a prospective cohort study to investigate the correlations between results from CRS- and asthma-specific questionnaires. Thirty-two patients with asthma and CRS were evaluated before and after undergoing nasal surgery at a tertiary medical center.There were significant correlations between the results from the Asthma Control Test (ACT) and the Sino-Nasal Outcome Test-22, as well as between the results of the ACT and Rhinoconjunctivitis Quality of Life Questionnaire, at both the preoperative and 3-month postoperative evaluations (P < 0.01). Moreover, nasal surgery improved the sinonasal symptoms, asthma control, and pulmonary function (P < 0.01).Increasingly severe sinonasal symptoms of CRS were associated with poor asthma control. Therefore, CRS and asthma should be considered and treated as common airway diseases.

Asthma history, job type and job changes among US nurses

ObjectivesNurses are at increased risk of occupational asthma, an observation that may be related to disinfectants exposure. Whether asthma history influences job type or job changes among nurses is unknown....

Patients’ Views on Asthma-Specific Quality of Life Questionnaires: Qualitative Interview Study in Germany

Objective. It is unclear which of the commonly used asthma-specific quality of life (QoL) questionnaires best capture the lived experience of people with asthma. The objective of this study was to explore patients’ views on three asthma-specific QoL questionnaires. Methods. Ten adult individuals with asthma were asked to complete three asthma-specific QoL questionnaires (Standardized Juniper Asthma Quality of Life Questionnaire (AQLQ-J-s), Sydney Asthma Quality of Life Questionnaire (AQLQ-S), and Fragebogen zur Lebensqualität bei Asthma (FLA)). Interviews were conducted to elicit patients’ views on the questionnaires. Interviews were transcribed verbatim and thematic content analysis was performed. Results. Participants spoke about response format and options, missing and redundant/similar content as well as content that was perceived to be irrelevant. A lack of specificity was named for some items, and issues concerning layout were raised. Despite the diversity of views expressed, participants mostly agreed on the ranking of the questionnaires and, overall, favored the AQLQ-S. Conclusions. Patient involvement highlights shortcomings and strengths of various asthma-specific questionnaires in terms of both format and content. The AQLQ-S was the most positively perceived questionnaire. Future research will need to explore other settings and potentially involve a larger and more diverse sample.

Improving Asthma Care for the Elderly: A Randomized Controlled Trial Using a Simple Telephone Intervention

Background. Several studies suggest that asthma is undertreated in the elderly population. Objective. To determine if the use of a simple telephone intervention can improve asthma care in the elderly. Methods. Fifty-two elderly subjects with asthma who required their rescue inhalers more than twice a week and had at least one emergency department or urgent care visit in the previous year were randomized to an intervention or control group. All subjects received two telephone calls over a 12-month period. The intervention group received an asthma-specific questionnaire and the control group received a general health questionnaire. Medication use and health care utilization were evaluated at the beginning and end of a 12-month period. Results. The study was completed by 23 control and 25 intervention subjects. Baseline data were similar in both groups. After 12 months, 72% (n = 18) of the intervention group were on an inhaled corticosteroid compared with 40% (n = 10) of the control group (p = 0.08). The intervention group had fewer emergency department visits when compared with the control group (p = 0.21). Sixty-four percent (n = 16) of the intervention group had an asthma action plan compared with 26% (n = 6) in the control group (p = 0.01). Conclusion. This study suggests that asthma care in the elderly can be improved using a simple telephone intervention. Clinical implications. Clinicians need to recognize that under treatment of asthma in the elderly still exists and to use alternative methods such as a simple telephone questionnaire to improve care in this population.

Comparison of the Asthma Health Questionnaire-33-Japan and the Short-Form 36-Item Health Survey for Measuring Quality of Life in Japanese Patients with Asthma

The Asthma Health Questionnaire (AHQ)-Japan is useful for assessing quality of life (QOL) in Japanese patients with asthma. However, no studies have compared the AHQ-Japan to other QOL instruments. The AHQ-33-Japan and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) were completed simultaneously by 126 Japanese patients with asthma (48 men, 78 women; 58.1 +/- 17.3 years of age), and the data were compared. Poor negative correlations (correlation coefficient (r) = -0.20 to -0.44, P < 0.05) were observed for 38 combinations of the subscales of these QOL instruments. As the severity of the patients' asthma increased, the scores of most subscales of both QOL instruments became worse. However, the AHQ-33 was more sensitive for severity than the SF-36. On logistic regression analysis, high Asthmatic Symptoms, Factors which Worsened Symptoms, Emotion, Daily Activity, and Social Activity subscale scores, as well as a high total 32-item score, of the AHQ-33 were associated with an increased risk of moderate to severe asthma. On the other hand, only the Physical functioning subscale score of the SF-36 was associated with an increased risk of moderate to severe asthma. Our results show that the AHQ-33 is useful as a disease-specific QOL instrument in Japanese patients with asthma and that it is better than the SF-36, which is a generic QOL instrument. In the future, the AHQ-33 should be compared to other asthma-specific questionnaires.

Impact of an asthma-specific questionnaire on problem identification and clinical and economic outcomes in ambulatory patients with persistent asthma

ObjectiveTo determine the impact of an asthma-specific questionnaire on problem identification and patient outcomes. DesignProspective, two-group, parallel, randomized, multisite study. SettingConducted at 10 community pharmacies in suburban Detroit from January 2000 to April 2003. Patients60 adult and pediatric patients with persistent asthma receiving daily medication. InterventionA 17-item questionnaire designed to query understanding of and response to therapy and confidence in asthma prevention and treatment was completed by all participants at routine visits. Pharmacists reviewed questionnaire results with 31 intervention (group 1) participants during a 5- to 10-minute interaction, while 29 control (group 2) participants received standard care only. Main outcome measuresNumber and type of problems identified. Secondary outcomes were use of clinical outcomes, resource utilization, drug use and understanding, missed school or work days, and participant confidence. ResultsGroup 1 and group 2 participants were monitored for a mean of 5.4 and 5.2 months, respectively. Overall, 68 problems were identified in group 1 and 4 in group 2. Confidence in preventing asthma episodes improved 29% and confidence in treating symptomatic episodes improved 10% in group 1 participants, whereas there were no improvements in group 2. Symptom frequency, rescue drug use, restricted activity, and patients with more than two nocturnal episodes per month decreased within both groups. There were low incidences of and no statistically significant group differences for frequency of oral steroids, resource use, and missed school or work days. Likewise, group differences in drug use and understanding were not significant. ConclusionThe questionnaire aided pharmacists in problem identification and may be useful in a busy pharmacy. Study limitations such as small sample size, short follow-up period, and liberal enrollment contributed to the lack of group differences in our secondary outcomes. Future studies need to address our study limitations and explore additional practical methods of providing pharmaceutical care in the community pharmacy setting.

Chiropractic co-management of medically treated asthma

Asthma is the most common chronic disease in the UK. An inflammatory disorder, it is characterized by increased mucus production and airway hypersensitivity, both of which contribute to a decreased airflow. Common symptoms include shortness of breath, wheezing, coughing and a feeling of chest tightness. This article presents three cases where patients, being treated by conventional pharmacological means, had chiropractic manipulation administered to the upper thoracic spine twice a week for a period of 6 weeks. Objective measurements were collected using a peak flow meter and subjective data using an asthma specific questionnaire. All three cases resulted in increased subjective and objective parameters and suggest the need for larger studies with appropriate methodology.

Validation Study of a Disease-specific Module, the Asthma Health Questionnaire (AHQ) Using Japanese Adult Asthmatic Patients

An asthma-specific questionnaire, the Asthma Health Questionnaire (AHQ) was developed for Japanese asthmatic patients. A self-administered 37-item version (AHQ-37) consisting of 36 disease-specific items and a Face Scale was designed for socially active patients. Exploratory factor analysis, test-retest reliability, internal consistency, concurrent validity and longitudinal validity were evaluated. A total of 326 asthma patients (202 men; range of age from 18 to 65 years) answered the AHQ-37 twice. Each item of the AHQ-37 was well accepted by the patients with answering rates of 95 to 100%. Six subscales (Asthmatic Symptoms, Emotion, Daily Activity, Factors which Worsened Symptoms, Social Activity and Economics) were extracted by factor analysis. Psychometric testing showed high feasibility, good repeatability and good internal consistency. The Face Scale moderately correlated with all subscales except for Economics, indicating that the Face Scale alone could measure global quality of life (QOL) functioning of asthmatic patients. Concurrent validity with peak-flow values was insufficient (Spearman’s correlation coefficient = 0.05−0.27), showing that the peak flow alone could not estimate QOL. In longitudinal validity, however, changes in peak-flow values had an impact on the Asthmatic Symptoms, Daily Activity and Factors which Worsened Symptoms ( P = 0.000−0.419), indicating that changes in peak-flow were important to asthmatic patients’ QOL. The QOL of asthmatic patients must be evaluated by asthma-specific questionnaires, such as the AHQ-37.

Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients

Background: This study was undertaken to derive and validate a short form parent-completed questionnaire to measure health-related quality of life (HRQL) in pediatric asthma patients. Objective: The objectives of this study were to (1) use stepwise analysis to derive a shorter questionnaire from the original long-form questionnaire and (2) determine the tradeoff in precision between the long- and short-form surveys. Methods: One hundred eighty-one pediatric asthma patients were enrolled from 4 sites. A parent of each patient completed a general and an asthma-specific questionnaire during routine office visits from June 1995 to January 1997. The questionnaire included the Child Health Questionnaire Parent Form 50, a general HRQL survey, and a 17-item asthma-specific battery assessing daytime symptoms, nighttime symptoms, and functional limitations. All scales were scored from 0 to 100, with higher scores indicating better HRQL. Analysis of variance models were used to derive short-form scales from the 17-item long-form scales, and the final asthma-specific short-form scale structure was confirmed with use of stepwise regression. Scale reliability was assessed with Cronbach’s α. Validity of the short-form questionnaire was assessed by comparing mean scale scores according to the level of asthma severity defined by several clinical criteria. Asthma severity was assessed with use of percent predicted FEV1, frequency and type of symptoms, parent rating of disease severity, physician rating of disease severity, and resource use (emergency department use and hospitalizations). The relative validity of each of the short-form scales was measured by comparing the proportion of variance explained by each of the short-form scales compared with the respective long-form scales. Results: The 17-item asthma-specific battery was reduced to 8 items, the Integrated Therapeutics Group Child Asthma Short Form. The daytime and nighttime symptom scales for each contain 2 items and the functional limitations scale 4 items. Reliability was greater than 0.70 for each of the short-form scales. The absence of ceiling and floor effects indicates each scale’s ability to detect changes at both low and high levels of functioning. Lower (poorer) mean HRQL scores for severe cases compared with mild cases, for all disease severity indicators, demonstrated clinical validity. Relative validity estimates, comparing the proportion of explained variance of the short-form scales with that of the long-form scales, ranged from 0.85 to 1.20, indicating a similar ability to measure change. Conclusions: This study documents the development of a brief, multidimensional, 8-item questionnaire for measuring HRQL in pediatric asthma patients. The brevity of the questionnaire makes it practical for use in practice settings and to monitor patients. (J Allergy Clin Immunol 2000;105:245-51.)

Impact of Fluticasone Propionate Powder on Health-Related Quality of Life in Patients with Moderate Asthma

Because biological indicators alone do not adequately represent the comprehensive health status of a patient with asthma, we also assessed patients' health-related quality of life (HRQOL) in a randomized, double-blind, placebo-controlled study of the effects of the inhaled corticosteroid fluticasone propionate (FP). A total of 342 patients with moderate asthma were treated twice daily for 12 weeks with FP powder (50,100, or 250 μg) or placebo. At regular intervals, patients completed the Medical Outcomes Study Short Form-36, acute version (SF-36A), a general health status questionnaire measuring eight dimensions of HRQOL; the 20-item Living with Asthma (LWA-20) questionnaire, a disease-specific instrument measuring HRQOL; and three additional questions related to sleep loss and number of nighttime awakenings. Each of the three FP groups compared with placebo had significantly higher scores at study endpoint on the Physical Functioning (p < 0.001) and Role-Physical (p < 0.0001) dimensions of the SF-36A; the FP 100- or 250-μg groups compared with placebo also had significantly higher scores on General Health Perceptions (p < 0.03), Vitality (p < 0.007), and Mental Health (p < 0.02). At endpoint, all three FP groups compared with placebo had significantly better scores on the LWA questionnaire (p < 0.05) and on the sleep-related items (p < 0.0001). These data, collected using both a general health status questionnaire and an asthma-specific questionnaire, demonstrate that fluticasone propionate powder can improve HRQOL in patients with mild-to-moderate asthma.