Living With Asthma Questionnaire Research Articles

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...

Cross-cultural adaptation and validation of the Portuguese version of the Living with Asthma Questionnaire

Abstract Objective To translate and culturally adapt the Living with Asthma Questionnaire (LWAQ) to the Portuguese language and to test its reliability and validity. Methods The Portuguese version of this disease-specific health-related quality of life measure was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese LWAQ and Medical Outcomes Study – 36 item Short Form (SF-36) questionnaires, and a form for the characteristics of the patients were administered to 61 subjects with asthma. Results Reliability of LWAQ scores was good with Cronbach's alpha coefficients ranging from 0.70 to 0.97 [with the exception of “preoccupation” (0.62) construct, and “sleep” (0.67) and “effects on others” (0.47) domains] and intraclass correlation coefficients between 0.86 and 0.99. Construct validity was supported by the confirmation of predefined hypotheses involving expected significant correlations between LWAQ total, constructs and domains, and SF-36 dimensions with similar content. Conclusion The Portuguese LWAQ exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity.

Adaptação cultural e validação da versão portuguesa do Living with Asthma Questionnaire

ObjectiveTo translate and culturally adapt the Living with Asthma Questionnaire (LWAQ) to the Portuguese language and to test its reliability and validity. MethodsThe Portuguese version of this disease-specific health-related quality of life measure was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese LWAQ and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, and a form for the characteristics of the patients were administered to 61 subjects with asthma. ResultsReliability of LWAQ scores was good with Cronbach's alpha coefficients ranging from 0.70 to 0.97 [with the exception of «preoccupation» (0.62) construct, and «sleep» (0.67) and «effects on others» (0.47) domains] and intraclass correlation coefficients between 0.86 and 0.99. Construct validity was supported by the confirmation of predefined hypotheses involving expected significant correlations between LWAQ total, constructs and domains, and SF-36 dimensions with similar content. ConclusionThe Portuguese LWAQ exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity.

Health outcomes, education, healthcare delivery and quality – 3047. What do patients think about asthma-specific quality of life questionnaires? Qualitative interview study in the UK

Methods 22 adult individuals with asthma were asked to complete three asthma-specific quality of life questionnaires (Juniper Asthma Quality of Life Questionnaire (AQLQ-J), Sydney Asthma Quality of Life Questionnaire (AQLQ-S), Living With Asthma Questionnaire (LWAQ)). Interviews were conducted to elicit patients’ views on the content validity of the questionnaires and transcribed verbatim. Thematic content analysis was performed.

Measuring asthma‐specific quality of life: structured review

Measuring quality of life (QoL) has become an increasingly important dimension of assessing patient well-being and drug efficacy. As there are now several asthma QoL questionnaires to choose from, it is important to appreciate their strengths and weaknesses. To assist in this choice, we have reviewed the existing questionnaires in a structured way. Information relating to the conceptual and measurement model, reliability, validity, interpretability, burden, administration format and translations was extracted from the published literature. The instruments differ in almost all criteria considered, and therefore it cannot be assumed that they measure the same thing. We recommend the selection of questionnaires that are designed only for asthma and that do not assess symptoms as part of QoL. Only two of the questionnaires reviewed fulfill these requirements: the Sydney Asthma QoL Questionnaire (AQLQ-S) and the Living with Asthma Questionnaire (LWAQ). However, for multinational studies, it may be convenient or practical to use questionnaires that have been linguistically validated in many languages (AQLQ-J, SGRQ). It remains unclear which of these questionnaires best reflects patient perceptions of QoL. Our review did not involve patients, so for the time being choosing from existing questionnaires requires a compromise based on the rigor of the development process and the target patient group.

The Relationship Between Disease Control, Symptom Distress, Functioning, and Quality of Life in Adults with Asthma

Purpose. The purpose of this study was to evaluate quality of life (QOL) from a multidimensional perspective in relation to asthma control, symptom distress, and functioning in adults with asthma. Methods. A cross-sectional, mailing survey design was used. The convenience sample of 172 people diagnosed with asthma participated in this study. QOL, conceptualized as subjective satisfaction with life, was measured by the Quality of Life Index-Pulmonary Version III (QLI-PV III). Functioning was measured with the Living with Asthma Questionnaire (LWAQ). Instruments measuring asthma control and symptom experience have been developed for this study. Multiple regression and path analysis were used to examine the relationships. Results. The QOL was affected directly by functioning (β = −0.70). Asthma control and symptom distress were indirectly influencing QOL. Among the predictors, direct paths were found between asthma control and functioning (γ = 0.20), and between symptom distress and functioning (γ = 0.57); 51% of the total variation in functioning was explained by symptom distress and asthma control; 48% of the total variation in QOL was explained by functioning. Conclusion. The findings highlight the importance of symptom distress and control of asthma symptoms with respect to functioning and QOL in people with asthma.

Asthma in women with endometriosis

This study aimed to investigate asthma prevalence and severity in women with and without endometriosis. Before laparoscopy, asthma prevalence was evaluated in 879 women of reproductive age, undergoing surgery because of benign gynaecological conditions. Diagnosis of bronchial asthma was based on the American Thoracic Society criteria; asthma severity was classified in four categories according to the 2002 Global Initiative for Asthma guidelines. Asthmatic patients completed the Living with Asthma Questionnaire (LWAQ). Endometriosis was confirmed histologically and classified according to the revised American Fertility Society criteria. There were no significant differences in age, smoking status, and other demographic and health characteristics between patients with endometriosis (n = 467) and controls (n = 412). Asthma prevalence was similar in women with (23/467, 4.9%; 95% CI, 3.1-7.3) and without (22/412, 5.3%; 95% CI, 3.4-8.0; P = 0.781) endometriosis. Asthma severity was similar in women with and without endometriosis, with 12 (52.2%) women with endometriosis and 13 (59.1%) controls being in the intermittent (mildest) degree of severity. No significant difference was observed between women with and without endometriosis in the LWAQ total score. Women with endometriosis do not have an increased risk of having asthma.

Health‐Related Quality of Life in Stable Asthma: What Are Remaining Quality of Life Problems in Patients with Well‐Controlled Asthma?

We purposed to examine the distribution of the disturbances in the health‐related quality of life (HRQoL) and to determine the relationship between HRQoL and various clinical parameters in patients with well‐controlled asthma according to the guidelines. We enrolled 162 patients with stable asthma, and 113 were defined as well‐controlled. HRQoL was measured by the Living with Asthma Questionnaire (LWAQ), the St. George's Respiratory Questionnaire (SGRQ), and the short‐form 36 health survey questionnaire (SF‐36), dyspnea by the Medical Research Council (MRC), and psychological status by the Hospital Anxiety and Depression Scale (HADS). In both stable and well‐controlled patients, the frequency distributions showed that the scores on the Avoidance, Distress, and Preoccupation constructs on the LWAQ were widely distributed, whereas the scores on the Vitality and General Health scales on the SF‐36 were normally distributed. In patients with well‐controlled asthma, the HADS had mild to moderate correlations with all questionnaires. Multiple regression analysis showed that the Anxiety, the MRC scale and the treatment steps accounted for 44% of the variance in the Avoidance on the LWAQ. These results suggest that domains of psychological well‐being may continue to be affected even though the asthma patients are well‐controlled by guideline criteria.

A Comparison of Two Simple Measures to Evaluate the Health Status of Asthmatics: The Asthma Bother Profile and the Airways Questionnaire 20

Simple and concise measures for health status are desirable in clinical practice. The Asthma Bother Profile (ABP), which consists of 23 items, has been developed to assess how much asthma bothers patients. The Airways Questionnaire 20 (AQ20) is a simple instrument which consists of 20 items. The purpose of this study was to investigate how the ABP and AQ20 evaluate the health status of patients with asthma. A total of 166 patients with chronic asthma (age: 48 ± 16 yr, 77 males) completed pulmonary function testing, measurement of airway hyperresponsiveness, dyspnea rating, assessments of their anxiety and depression (HADS; Hospital Anxiety and Depression Scale), and assessments of their health status. The health status was assessed using the ABP, AQ20, the short‐form 36 health survey questionnaire (SF‐36), the Living With Asthma Questionnaire (LWAQ) and the Asthma Quality of Life Questionnaire (AQLQ). The Japanese version of the ABP included only 15 ‘bother’ items out of the original 23 items due to cultural differences. The scores on the ABP were widely distributed, whereas the scores on the AQ20 were skewed towards the milder end of the scale. The ABP had a strong correlation with the Avoidance and Distress constructs on the LWAQ, and Anxiety and Depression on the HADS (Rs = 0.56 ∼ 0.79), and its strongest correlation with the General Health (Rs = − 0.64) scale among the 8 subscales on the SF‐36. The AQ20 had a less significant correlation with the LWAQ, AQLQ, and SF‐36 than the ABP. The ABP and AQ20 were short and simple to complete, and both measures could easily be used in clinical practice. The ABP can evaluate patients more specifically with respect to distress and bother than the AQ20.

Comparison of the Responsiveness of Different Disease-Specific Health Status Measures in Patients with Asthma

Disease-specific health status measures are characterized by higher responsiveness than generic measures and may be preferred in clinical trials. However, comparisons of responsiveness between various disease-specific measures have rarely been performed in asthma studies. We investigated and compared the responsiveness of health status scores in asthmatic patients during treatment using three different disease-specific measures: the Juniper Asthma Quality of Life Questionnaire (AQLQ), the Living with Asthma Questionnaire (LWAQ), and the Airways Questionnaire 20 (AQ20). We attempted to follow up 170 patients with newly diagnosed asthma over a 6-month period. Patients underwent treatment with inhaled corticosteroids in accordance with the guideline. A health status evaluation using three disease-specific measures, and pulmonary function tests were performed on the initial visit, and at 3 months and 6 months. The effect size and the standardized response mean were used as responsiveness indexes. A total of 109 patients completed the 6-month follow-up and were then analyzed. All health status scores and FEV(1) measures improved during the first 3 months (p < 0.001). The total of the AQLQ scores showed high responsiveness indexes ranging from 1.28 to 1.46 between baseline and 3 months, and baseline and 6 months. Spearman correlation coefficients were smaller between the change in FEV(1) and the change in the LWAQ. Although the AQ20 also demonstrated high responsiveness, a ceiling effect was indicated. The AQLQ was the most responsive measure during asthma treatment. The relationship between the change in airflow limitation and the change in the LWAQ was weaker compared to the AQLQ and the AQ20. Although the AQ20 was also responsive and its simplicity is favorable, the ceiling effect should be considered when using it.

Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life

Quality of life measures are increasingly used as important efficacy endpoints in studies of drugs for asthma. The purpose of this study was to assess both the sensitivity to change and the construct validity of four different quality of life instruments in patients with asthma. In a double-blind, parallel group study, 120 moderate asthma patients, aged between 18-70 yrs, received either inhaled salmeterol 50 micrograms b.i.d. or inhaled salbutamol 400 micrograms b.i.d. In addition to respiratory outcomes, quality of life was measured at a 6 weeks follow-up using: 1) Asthma Quality of Life Questionnaire (AQLQ); 2) Living With Asthma Questionnaire (LWAQ); 3) Sickness Impact Profile (SIP); 4) Rating Scale (RS); and Standard Gamble (SG) utilities. Salmeterol led to significant improvements over salbutamol on virtually all clinical outcomes. Although all the quality of life instruments showed the same trend in favour of salmeterol, only the AQLQ and RS utilities showed significantly greater improvement on salmeterol than on salbutamol. Except for the AQLQ, the correlation between change in lung function and change in quality of life was generally low. Whereas, the AQLQ correlated well with the patient's overall assessment of efficacy (r = 0.64), the LWAQ, SIP and utilities failed to show such a correlation. The AQLQ showed the best correlation with symptom scores. The cross-sectional correlation between the AQLQ and the LWAQ was 0.73, whereas the longitudinal correlation was only 0.29. The SG generally showed poor correlation with other measures, including the RS. In conclusion, patients given salmeterol showed a greater improvement in quality of life compared to patients given salbutamol. Of the disease-specific questionnaires the Asthma Quality of Life Questionnaire was found to be more responsive to change than the Living With Asthma Questionnaire and showed greater validity. Of the generic instruments, the rating scale utilities were most responsive. The Standard Gamble showed poor correlation with other measures.