Mini Asthma Quality Of Life Questionnaire Research Articles

Quantification of Glucocorticoid-Associated Morbidity in Severe Asthma Using the Glucocorticoid Toxicity Index

Glucocorticoid (GC)-associated morbidity in severe asthma (SA) is well recognized but varies in individual patients; systematic measurement of GC toxicity is important to measure improvement with steroid-sparing monoclonal antibodies. To describe for the first time individual patient GC toxicity in steroid-dependent SA using the Glucocorticoid Toxicity Index (GTI). An observational consecutive patient cohort study was performed at a UK Regional SA Specialist clinic for systematic assessment of GC-associated morbidity using the GTI in routine clinical care. GTI was correlated with commonly used patient-reported outcome measures. An approach to GTI scoring, calculation of minimal clinically important difference (MCID), and development of digital GTI application in routine clinical care are described. All patients had significant oral GC exposure (cumulative prednisolone/prior year, 4280 [3083, 5475] mg) with wide distribution of toxicity in individual patients (mean GTI score, 177.5 [73.7]). GTI score had only modest correlation with recent prednisolone exposure: maintenance prednisolone dose (rho= 0.26, P= .01), cumulative exposure/prior year (rho= 0.38, P < .001), and GC boosts/prior year (rho= 0.25, P= .01). GTI toxicity demonstrated stronger associations with asthma-related quality of life (mini-Asthma Quality of Life Questionnaire [mini-AQLQ] r=-0.50, P < .001 and St. George's Respiratory Questionnaire r= 0.42, P < .001). GTI MCID was calculated as 10 points. Multiple linear regression demonstrated that age and mini-AQLQ were strongest predictors of GC toxicity. The GTI is a useful tool to systematically capture and quantify GC toxicity at the individual patient level. GC toxicity varies widely between individual patients with SA and correlated only modestly with GC exposure over the preceding year. Age and mini-AQLQ are better predictors of GC toxicity. The GTI and MCID will facilitate assessment of individual SA response to steroid-sparing agents in clinical trials and routine care.

Real-World Effectiveness of Benralizumab in Severe Eosinophilic Asthma

Benralizumab is an IL5-receptor monoclonal antibody licensed for the treatment of severe eosinophilic asthma (SEA). It has demonstrated efficacy in clinical trials in reducing asthma exacerbation rates and maintenance oral corticosteroids (mOCSs). What is the real-world effectiveness of benralizumab and what baseline characteristics are associated with response to therapy? We assessed outcomes in all SEA patients who began benralizumab treatment at our specialist center. At each dosing visit, exacerbation history, mOCS dose, spirometry, and Asthma Control Questionnaire (ACQ6) and Mini-Asthma Quality of Life Questionnaire (mAQLQ) scores were recorded. Response to treatment was defined as a reduction of≥ 50%in annualized exacerbation rate (AER) or in mOCS dose after 48weeks of treatment. Super response was defined as zero exacerbations and no mOCSs for asthma. One hundred thirty patients were included in the analysis. At 48weeks, a 72.8%reduction in AER was noted, from 4.92 ± 3.35 per year in the year preceding biologic treatment to 1.34 ± 1.71 per year (P< .001), including 57 patients (43.8%) who were exacerbation-free with benralizumab. In those receiving mOCSs (n= 74 [56.9%]), the median daily prednisolone dose fell from 10mg (interquartile range, 5-20mg) to 0mg (interquartile range, 0-5mg; P< .001), and 38 of 74 patients (51.4%) were able to discontinue mOCS therapy. Clinically and statistically significant improvements were found in ACQ6 scores, mAQLQ scores, and FEV1. Overall, 51 patients (39%) met the super responder definition and 112 patients (86%) met the responder definition. The optimal regression model of super responders vsother responders included baseline characteristics associated with a strongly eosinophilic phenotype and less severe disease. Eighteen patients (13.8%) were nonresponders to benralizumab. Evidence of chronic airway infection was observed in 6 of 18 patients, and an increase in the blood eosinophil count consistent with the development of anti-drug antibodies was observed in 5 of 18 patients. In a large real-world SEA cohort, benralizumab led to significant improvements in all clinical outcome measures. A lack of response was seen in a minority of patients and should be a focus for future investigation.

Assessment of Asthma Control and Quality of Life among Asthmatic Patients Attending Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia.

Background The primary goal of asthma management is to achieve good asthma control. However, poor patient-physician communication, unavailability of appropriate medications, and lack of long-term goals have made asthma control difficult in developing countries. Poor assessment of asthma control and quality of life is a major cause of suboptimal asthma treatment worldwide, and information regarding this issue is scanty in developing countries like Ethiopia. This study thus attempted to assess the level of asthma control and quality of life in asthmatic patients attending Armed Forces Referral and Teaching Hospital. Methods A cross-sectional study comprising 184 physician-diagnosed asthmatic patients was conducted using interview, chart review, and prescription assessment. Asthma control was assessed using Asthma Control Test, while asthma quality of life was assessed using Mini-Asthma Quality of Life Questionnaire (mini-AQLQ). Spearman's rank correlation analysis was performed to understand the relationship between mean mini-AQLQ score and asthma control. Receiver operating characteristic curve analysis was performed to establish cut-off values for mini-AQLQ. Results Asthma was uncontrolled in 67.9% subjects. There was a strong correlation between asthma control and quality of life (rs = 0.772; P < 0.01). A cut-off value for the quality of life was established at 4.97. Majority of the patients were taking two or three antiasthmatic drugs. Oral tablet and inhaler short-acting beta agonists (SABA) were the frequently combined drugs. Uncontrolled asthma was associated with middle-aged adults (adjusted odds ratio (AOR) = 6.31; 95% CI: 2.06, 19.3; P = 0.001), male gender (AOR = 0.38; 95% CI: 0.15, 0.98; P = 0.044), married (AOR = 0.24; 95% CI: 0.08, 0.78; P = 0.017), comorbidities (AOR = 0.23; 95% CI: 0.09, 0.61; P = 0.003), and oral SABA use (AOR = 0.22; 95% CI: 0.09, 0.59; P = 0.003). Male gender (AOR = 0.36; 95% CI: 0.16, 0.84; P = 0.018), intermittent asthma (AOR = 0.18; 95% CI: 0.04, 0.86; P = 0.032), use of oral corticosteroids (AOR = 0.22; 95% CI: 0.06, 0.73; P = 0.013), and SABA (AOR = 0.39; 95% CI: 0.17, 0.89; P = 0.026) were found to have a significant association with poor asthma-related quality of life. Conclusion The findings collectively indicate asthma remains poorly controlled in a large proportion of asthma patients in the study setting. Moreover, quality of life appears to be directly related to asthma control. Healthcare providers should therefore focus on asthma education with an integrated treatment plan to improve asthma control and quality of life.

Evaluating the Clinical Outcomes of Three Medication Regimens for Treating a Sample of Iraqi Persistent Asthmatic patients

Abstract&#x0D; Asthma is a complex disease defined by chronic airway inflammation and airflow limitation causing variable respiratory symptoms which include shortness of breath (SOB), wheezing, chest tightness and cough. Asthma guidelines advocate adding a second long acting bronchodilator to medium doses of inhaled corticosteroids (ICS) rather using high doses of ICS alone to control moderate to severe persistent asthma. The aim of this study was to evaluate the clinical outcomes of three medication regimens indicated for Iraqi patients suffering from persistent asthma. &#x0D; This study was interventional randomized clinical study conducted on a sample of adult Iraqi asthmatic patients in Baghdad City. The study composed of three visits distributed over eight weeks; baseline visit followed by first follow up and second follow up visits after four and eight weeks respectively. The study enrolled 78 adult patients with moderate to severe persistent asthma as diagnosed by specialist physician according to patient history and baseline pulmonary function test (PFT) and allocated them randomly to three groups (each group included 26 patients) to receive equivalent medium doses of budesonide inhaler in addition to either formoterol inhaler, oral modified release aminophylline tablets or tiotropium inhaler (first, second and third group respectively). Sixty four patients completed this study. The mean ages of patients were above 35 years with slightly more male predominance.&#x0D; The study groups developed significant increase of peak expiratory flow rate (PEFR) and forced vital capacity (FVC) values at the first follow up visit compared to baseline values (p&lt;0.001). Thereafter, the first and third groups achieved significant higher values at the second follow up visit compared to first follow up visit (p&lt;0.001), while second group produced no change. All the groups developed significant improvement of Mini asthma quality of life questionnaire (MiniAQLQ) scores and percentage of symptom free days (SFD) at first follow up visit and continued further significant improvement at the second follow up visit (p&lt;0.001). Generally, between groups comparison according to extent of change of study parameters revealed that third group produced the greatest improvement over the entire study period followed by the first group, whereas the second group was associated with the least extent of improvement.&#x0D; This study concluded that all groups caused significant improvement in study parameters compared to baseline values and also concluded that the third group of inhaled [tiotropium/budesonide] was associated with the highest extent of improvement followed by first group, while the second group was the least. &#x0D;

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.

Effectiveness of strengthening management in bronchial asthma control among community patients

Objective To evaluate the effectiveness of strengthening management in the bronchial asthma control among community patients. Methods One hundred and eighteen community patients with bronchial asthma were recruited from January 2017 to January 2018. The patients were divided into community strengthening management group (n=60) and control group (n=58), the annual times of acute attack, time to first exacerbation and annual medical expenses were compared between the two groups. The proportion of inhaled corticosteroid (ICS) administration was documented; the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), Leicester Cough Questionnaire (LCQ), Fractional exhaled nitric oxide(FeNO) and pulmonary function were evaluated in two groups. Results The management group had greater improvements in the proportion of ICS administration [45(75.0%) vs.36(62.1%), χ2=4.143], ACT [(20.7±3.9) vs.(18.1±4.1), t=3.213], LCQ [(13.5±5.3) vs.(10.8±3.0), t=2.603], FeNO [(29.8±12.8) vs. (37.1±11.1), t=2.018] than the control group after six months of management (all P 0.05) between two groups. The LCQ score [(16.5±4.2) vs. (13.5±5.3), t=3.186] and the MiniAQLQ score [(83.2±11.1) vs. (69.1±14.3), t=5.603] of the management group were significantly improved after 1 year of management than those after 6 months. There was significant improvement in time to first exacerbation [182(92, 284) vs. 92(58, 176), Z=4.384] and the annual exacerbation was significantly reduced [0(0, 1)vs. 2(1, 3), Z=-3.187], annual medical costs of management group were significantly lower than those of control group [(10 523.0±550.5)Yuan vs. (15 787.1±1 421.2)Yuan, t=2.653]. Conclusion The strengthening management can effectively improve the control rate of bronchial asthma, reduce acute exacerbation, improve clinical symptoms and improve the quality of life in community patients with bronchial asthma. Key words: Asthma; Community health services; Quality of life

The Long-Term Effectiveness and Safety of Omalizumab on Patient- and Physician-Reported Asthma Control: A Three-Year, Real-Life Observational Study.

Allergic asthma is a chronic inflammatory disease caused by immunoglobulin E (IgE)-mediated allergy. Omalizumab is a monoclonal anti-IgE antibody for the treatment of severe allergic asthma (SAA). The primary objective of the study was to assess asthma-related control in patients with SAA receiving omalizumab therapy. Secondary objectives included quality of life, treatment effectiveness, rate of severe exacerbations, and safety. This was a prospective, multi-centre, non-interventional study to assess patient-related long-term outcomes of omalizumab treatment in Germany. This 3-year study enrolled patients aged ≥ 18years with SAA. Asthma control was assessed using the asthma control questionnaire (ACQ-6) and physician-assessed global evaluation of treatment effectiveness (GETE). Exacerbations were recorded, and quality of life was assessed using the mini-asthma quality of life questionnaire (mini-AQLQ). Of 161 patients screened, 153 participated in this study. Most patients (92.2%) had been receiving prior omalizumab therapy for mean (SD) 2.9 (2.3) years. Omalizumab slightly decreased mean ACQ-6 score from 2.0 (1.22) at baseline to 1.7 (1.23) at the end of the 3-year treatment period [difference: -0.18 (1.07), P = 0.340]. Post-hoc analyses of ACQ-6 for the small number of treatment-naïve patients showed a decrease in mean (SD) ACQ-6 from 2.7 (1.08) at baseline to 1.4 (1.40) after 3years of omalizumab treatment. Mini-AQLQ increased from 4.5 (1.26) at baseline to 4.7 (1.48) after 3years [difference: 0.26 (1.35), P = 0.186]. GETE was reported as excellent or good for most patients (67.46-84.69%) and more than two-thirds had no severe exacerbation. There were no unexpected safety signals during the study period and no tachyphylaxis was observed. In conclusion, despite most patients receiving prior omalizumab treatment for approximately 3years, there was no decrease in effectiveness or safety over the subsequent 3years during this study. This supports the long-term use of omalizumab in maintaining asthma control and quality of life. Novartis Pharma GmbH, Germany.

Sociodemographic Factors and its Impact on Health Related Quality of Life (HRQoL) among Adult Asthma Patients in a Private Specialist Hospital in Malaysia

: Objectives: The present study aimed to explore the factors associated to asthma and HRQoL of patients. Asthma and Chronic obstructive pulmonary diseases implicate severe restrictions on physical, social and emotional aspects of the patients’ life. Health-related quality of life (HRQoL) is a patient derived measurement that defines the functional effects of illness and treatment, as perceived by the patient. Methodology: A descriptive cross-sectional study comprised of 100 asthma patients sampled in the outpatient department of KPJ Seremban Specialist Hospital. Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ) with two sections was used as instrument in this study. The first section comprises six (6) Sociodemographic questions and the second section comprises fifteen (15) questions of HRQoL covering four main domains such as emotional, activity, symptoms and environmental. Results: The sociodemographic factor that correlated positively with HRQoL in all domains of the AQLQ was the higher education level of patients. Factors that negatively influenced the entire AQLQ domain were the older age of the patients and lower occupation status. The most affected domain of AQLQ due to asthma is the emotional domain and the least affected domain is the activity domain. Conclusion: This study represents that age decreased the HRQoL of patients and concluded that higher education level contributes to better HRQoL scores and implies that higher education plays a pivotal role in HRQoL and we believe that it can be improve by reinforcing Health education.Key words: Bronchial Asthma, Health related quality of life, Sociodemographic factors, Symptoms domain, Activity domain, Emotional domain, Environmental domain.

The Role of Primary Care in Asthma Control and Severity

Background: Asthma is a common chronic inflammatory disease of the airways affecting 3 millionCanadians. Primary Care Providers (PCPs) are integral to care coordination, enhanced through thedevelopment of a strong patient-PCP relationship with Continuity of Care (COC). A recent CIHI studynoted that 40% of Albertans do not have a COC model for primary care.Objectives: We aim to evaluate how primary care for adults with asthma impacts different measures ofcontrol.Methods: Prospective population-based recruitment of adults through various community venuesacross Alberta. Those who had self-reported asthma and were willing to participate completed a surveywhich included demographics, comorbidities, medication use (including biologics, allergy medications,steroids), Asthma Control Questionnaire (ACQ-5), Asthma Control Test (ACT), Quality of Life (QoL)measured through the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) and health care utilization(including Emergency Department (ED) visits, hospitalizations and ICU stays for asthma).Results: Of the 1685 individuals approached, 61 (3.6%) reported having asthma, of which 47 lived inAlberta. Most (41, 87%) had a PCP, with 30 (64%) visiting their PCP at least twice a year. Uncontrolledasthma was noted in 21 (45%) with either the ACQ-5 or ACT. The mini-AQLQ indicated 5 (11%) withreduced QoL. Mean lifetime hospitalizations, lifetime Emergency Department (ED) visits, and ICU staysrelated to asthma were 1.52, 4.55 and 0.25 respectively. Further, mean hospitalizations and ED visits inthe past 12 months related to asthma were 0.05 and 0.30 respectively.Conclusions: Asthma control was poor in 21 (45%) surveyed individuals, suggesting sub-optimal asthmamanagement in Alberta. Knowledge of Primary Care Networks (PCNs) was low, while ED and hospitalusage was high.

Effectiveness and Patient Satisfaction with Budesonide/Formoterol Easyhaler® Among Patients with Asthma or COPD Switching from Previous Treatment: a Real-World Study of Patient-Reported Outcomes.

IntroductionPersistent symptoms, poor disease control, and reduced quality of life (QoL) are common in patients with asthma and chronic obstructive pulmonary disease (COPD). Current therapies are only partially effective and inhaler misuse contributes to insufficient disease control and poor outcomes. This real-world study aimed to evaluate the effectiveness of budesonide/formoterol fumarate (B/F) Easyhaler® in everyday clinical practice in Hungary.MethodsPost hoc, subgroup analyses of this 12-week, real-world, multicenter, open-label study were conducted in adults diagnosed with asthma or COPD. Endpoints included the change in patient-reported outcome measures; i.e., symptoms and disease control measured by Asthma Control Test or COPD Assessment Test and health-related (HR)QoL measured by mini-Asthma Quality of Life Questionnaire or modified Medical Research Council dyspnea scale. Changes in lung function and patient satisfaction with B/F Easyhaler versus their previous inhaler were also evaluated. Results were stratified by the inhaler device used at visit 1 (baseline, when patients switched device); comparisons were made with B/F Easyhaler use after 12 weeks, assessed at visit 3.ResultsIn total, 398 and 563 patients with asthma and COPD, respectively, were analyzed. Significant improvements (p < 0.0001) in symptoms and disease control, HRQoL, and lung function were reported 12 weeks after switching treatment to B/F Easyhaler from the most commonly used devices (≥ 10% of patients). Significant increases in patient satisfaction were also reported versus comparators.ConclusionsPatients with asthma or COPD who switched to B/F Easyhaler from their previous inhaler due to lack of disease control achieved significant improvements in symptoms and disease control, HRQoL, and lung function within 12 weeks of real-world use with significant increase in patient satisfaction also observed. Such comparative information may reassure clinicians and patients that may be viewed as an appropriate and potentially beneficial treatment option.Trial Registration NumberOGYÉI/13942-5/2016 (National Pharmaceutical Institute of Pharmacy and Nutrition of Hungary).FundingOrion Corporation, Orion Pharma.Plain Language SummaryPlain language summary available for this article.Electronic supplementary materialThe online version of this article (10.1007/s41030-019-0097-7) contains supplementary material, which is available to authorized users.

A IMPACT OF A PHARMACIST-LED EDUCATIONAL INTERVENTION ON QUALITY OF LIFE AMONG PATIENTS WITH ASTHMA

Objectives: Asthma is a chronic disease resulting in reduced quality of life (QoL) of most affected individuals. Training in asthma-related knowledge, inhaler skills, medicine usage, and the prevention of adverse drug events is demonstrated to improve asthma patients’ QoL. Therefore, the research was conducted to evaluate the effectiveness of education intervention undertaken by pharmacists on QoL of patients with asthma.&#x0D; Methods: We conducted a clinical randomized controlled trial among asthmatic outpatients aged 18 years or older in the Department of Screening Respiratory Function, University Medical Center, Ho Chi Minh City, Vietnam. Patients were randomized into an intervention group (IG) and a non-IG (NIG). The clinical pharmacists’ intervention program included training in asthma-related knowledge, inhaler technique, recognition, prevention of adverse drug events, and lifestyle adjustment. Participant screening was conducted using the telephone on a monthly basis. QoL was measured using the Vietnamese Version of the Mini Asthma QoL Questionnaire (MiniAQLQ). The main outcome was the difference in QoL scores between IG and NIG after 3 months follow-up.&#x0D; Results: After 3 months, the number of patients with asthma in the IG and in the NIG was 173 and 96, respectively. QoL mean scores in the IG patients were significantly higher than those in their NIG counterparts (1.79±1.01 vs. 1.06±0.93, respectively, p&lt;0.001). Pharmacist-based interventions overall QoL scores (multivariate-adjusted regression coefficient =0.362; p&lt;0.001).&#x0D; Conclusions: Clinical pharmacist-led counseling can improve asthmatic patients’ QoL.

A Multicenter, Observational, Prospective Study of the Effectiveness of Switching from Budesonide/Formoterol Turbuhaler® to Budesonide/Formoterol Easyhaler®.

IntroductionIn real-life practice, asthma remains poorly controlled, with a considerable burden on patients’ quality of life. Budesonide/formoterol (B/F) Easyhaler® has demonstrated similar dose consistency, therapeutic equivalence, and equivalent bronchodilator efficacy to B/F Turbuhaler®, but no real-life comparisons are yet available in patients switching from B/F Turbuhaler® to B/F Easyhaler®.MethodsThe primary objective of this real-life, non-interventional, observational study was to show non-inferiority of asthma control when adult patients in Swedish primary care with persistent asthma switched from B/F Turbuhaler® to B/F Easyhaler®. At visit 1, baseline demographic and endpoint data were recorded, and eligible patients switched to B/F Easyhaler®. The study comprised a control visit (visit 2) and a concluding examination (visit 3) after 12 weeks. Asthma control was assessed using the Asthma Control Test (ACT). The mini-Asthma Quality of Life Questionnaire (AQLQ) and lung function test were performed, and participants and investigators answered questionnaires about ease-of-use and teaching.ResultsA total of 117 patients were enrolled in the on-treatment population; 81 (64.8%) were female. At visit 3, B/F Easyhaler® demonstrated non-inferiority to B/F Turbuhaler®; the mean difference in change from baseline ACT was statistically significant (18.9 vs. 20.7, respectively; p < 0.0001) and met the non-inferiority criteria of B/F Easyhaler® being greater than − 1.5 points versus the reference product. Asthma was well controlled in 62 (53.0%) patients at baseline, increasing to 83 patients (70.9%) at visit 3. Patients experienced statistically significant improvements in mini-AQLQ score after B/F Easyhaler® treatment and lung function remained stable across the treatment period. B/F Easyhaler® was easy to learn and prepare for use.ConclusionThis real-life, non-interventional, non-inferiority study in adults with persist asthma demonstrates equivalent or better disease control when patients switch from B/F Turbuhaler® to B/F Easyhaler®. A further study with direct comparison between treatments could add to the understanding of inhaler switch.FundingOrion Corporation, Orion Pharma.Electronic supplementary materialThe online version of this article (10.1007/s12325-019-00940-7) contains supplementary material, which is available to authorized users.

The effect of stress management incorporating progressive muscle relaxation and biofeedback-assisted relaxation breathing on patients with asthma: a randomised controlled trial

BackgroundPrevious evidence indicates a negative influence of elevated stress on asthma symptoms and asthma-related quality of life.Objective To investigate the effects of stress management (SM; progressive muscle relaxation accompanied by biofeedback-assisted relaxation breathing),on stress levels, asthma control, asthma-related quality of life and physical exercise in patients with intermittent and mild chronic asthma. MethodsThis is a phase 2, two-armed, parallel randomized controlled trial using an intervention SM group (N=23) and a usual care (UC) control group (N=19). The measurements included the Perceived Stress Scale (PSS), the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MAQLQ) and one Likert-type question measuring frequency of weekly exercise. The assessments were carried out at baseline and after 8 weeks. ResultsMost patients had experienced zero or one asthma exacerbation during the previous year, while the mean duration of the disease was about 14 years for both groups. No differences were noted between the two groups at baseline. Patients in the SM group showed significant less perceived stress (p<0.0001), better asthma-related quality of life (regarding symptoms, daily activity/limitations and emotional function) and asthma control (p <0.0001) and higher frequency of physical exercise (p=0.001) than patients in the UC group at the end of the follow-up. ConclusionsThis study provides more evidence in favor of the role of SM in the treatment of asthma. Future studies should replicate and expand these results.

The impact of patient autonomy on older adults with asthma

BackgroundUnderstanding patient preferences and desire for involvement in making medical decisions is important when managing chronic conditions. Previous studies have used the Autonomy Preference Index (API) in younger patients with asthma to evaluate these preferences. ObjectiveTo identify factors associated with autonomy and to determine whether autonomy is related to asthma outcomes among older adults. MethodsA total of 189 older adults (>55 years old) with persistent asthma were included. Preferences for autonomy were assessed using the API, with a higher score indicating higher desire for autonomy. Scores were separated into 2 domains of information-seeking and decision-making preferences. The separated scores were correlated with asthma outcomes and demographic variables. To control for confounding factors, a linear regression analysis was performed. ResultsHigher decision-making preference scores correlated with female sex (P = .007), higher educational level (P = .01), and lower depression scores (P = .04). Regarding outcomes, decision-making scores positively correlated with Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) scores (P = .01). On linear regression analysis, the Mini-AQLQ score remained significantly associated with decision-making preference scores (P = .03). There was no association with asthma control test scores, spirometry values, and health care use. Information-seeking preference scores correlated with educational level (P = .03), but there was no correlation with asthma outcomes. ConclusionOlder adults with asthma and a greater desire for involvement in decision making have better asthma-related quality of life. Future studies with the intention to increase patient autonomy may help establish a causal relationship.

Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population.

Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics. At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses. A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003). While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.

Fibromyalgia as a cause of uncontrolled asthma: a case–control multicenter study

Background: Fibromyalgia can affect the control of asthma when both diseases are present in a single patient.Objectives: To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control.Methods: This was a cross-sectional case–control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction.Results: Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant.Conclusions: Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life.Clinical implications: Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

Validity of a Chinese version of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and a comparison of completion by patients and relatives

ABSTRACTObjective: To test the psychometric properties of the Chinese version of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and to investigate the differences between the MiniAQLQ completed by patients (p-MiniAQLQ) and by their relatives (r-MiniAQLQ). Methods: One hundred and two asthmatic patients and 45 relatives were recruited. The reliability was evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC). The validity of the MiniAQLQ was assessed by comparing it with the Sydney Asthma Quality of Life Questionnaire (AQLQ-S) and lung function measurements. The mean quality of life scores were compared by gender and smoking history, and the p-MiniAQLQ scores were then compared with the r-MiniAQLQ scores. Results: The MiniAQLQ showed high internal consistency (Cronbach's alpha = 0.901) and a high two-week reproducibility (ICC = 0.863). The cross-sectional correlations between the MiniAQLQ and the AQLQ-S were strong. Correlations between the MiniAQLQ and lung function (predicted FEV1% and PEF) ranged from poor to weak at the total or domain levels. The MiniAQLQ scores were not significantly associated with gender or smoking history. There was poor agreement between the p-MiniAQLQ and r-MiniAQLQ scores at the total or domain levels. Conclusions: The Chinese version of the MiniAQLQ showed good reliability and validity. It is reliable for evaluating the impact of asthma on patients’ quality of life. Relatives of the patients did not have a comprehensive grasp of the patients’ conditions. Physicians should be cautious when patients’ relatives come to the hospital to seek a modified treatment when the patients are not present.

Effect of psychological and other factors on quality of life amongst asthma outpatients in Lagos, Nigeria

BackgroundThis study aimed to assess the effect of psychological and other possible factors associated with poor health related quality of life (HRQOL) in outpatient with asthma in Lagos, Nigeria. MethodsPatients (n = 201) recruited from the adult asthma outpatient clinic were assessed for sociodemographic and asthma related variables. Levels of social support (with Oslo 3-Item Social Support Scale), disability (with WHO Disability Assessment Scale) were assessed. The presence of anxiety and depression was assessed using the Mini International Neuropsychiatric Interview (M.I.N.I) and asthma related quality of life was assessed with the Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ). ResultsOf the 4 domains of Mini-AQLQ, the “environmental” domain has the lowest weighted mean score of 2.43 (SD = 1.64) while the “activity limitation” domain has the highest mean score of 4.74 (SD = 1.57). Poor asthma related QOL was independently associated with being unemployed (p = 0.028), poor social support (p = 0.002), nocturnal asthma (p = 0.046), clinically rated “severe asthma” (p = 0.002), patients rated “severe asthma” (p < 0.001), high level of disability (p < 0.001) and presence of Anxiety/Depression (p < 0.001). ConclusionOur study has shown that psychological variables, disability, patients' subjective severity rating and social support are the most important factors independently associated with asthma related QOL. These factors should be considered in planning health care services or formulating a predictive intervention model.

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial.

BackgroundWhether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.ObjectiveThe aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.MethodsA multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.ResultsA total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI –0.12 to 1.05) and 9 months (mean change 0.39, 95% CI –0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.ConclusionsThis study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals’ knowledge and self-management skills improve may result in long-term gains in asthma control.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea.

BackgroundContinuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies.MethodsProspective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention‐to‐treat basis.ResultsThe mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients’ weight.ConclusionsAsthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome.