Long-term change in health-related quality of life in patients with asthma

The aim of this study was to investigate long-term change in health-related quality of life (HRQL) in patients with asthma in real clinical practice and in relation to emotional disorders, cooperativeness (cooperation between the patient and the physician, and adherence to treatment), and cold air-provoked bronchial hyperresponsiveness (BHR).

Methods. This observational study involved 32 patients with mild to moderate asthma. The study duration was 7.5 to 10 years. HRQL was assessed using SF-36 questionnaire and Asthma Quality of Life Questionnaire (AQLQ); emotional disorders were diagnosed using Hospital Anxiety and Depression Scale (HADS). Patients’ cooperativeness assessment was based on number of a patient’s scheduled visits to a physician during the study. The asthma control level was evaluated using the Asthma Control Test (ACT).

Results. A significant worsening was found in the social activity domain of HRQL in the total group of the patients. According to AQLQ, a significant improvement was seen in the activity and symptoms domains and in the total score of quality of life (QoL). Long-term pharmacological treatment of asthma decreased anxiety and depression levels. The asthma control (ACT score) increased from 13.2 ± 1.0 to 19.7 ± 1.1 (р = 0.00003). Anxiety and depression decreased in patients with high cooperativeness during the long-term follow-up, while the total QoL and the specific QoL were unchanged excluding the social activity domain. A significant worsening in the activity scale and in the emotional scale of specific QoL together with growing depression and decreasing control of asthma were found in patients with lower cooperativeness. The cold air-provoked BNR slowed down the long-term improvement in the social activity domain. The cold air-provoked BNR also decreased patient-reported evaluation of daily activity.

Conclusion. The long-term basic therapy of asthma provides a positive trend in HRQL in the real clinical practice independently on worsening of the disease. Lower cooperativeness of a patient could decrease specific QoL, which, in turn, worsens the control of asthma and contributes to negative emotional background and destructive behavior.

1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2017. Available at: https://u.to/bF29FA.

2. Liga M.B. Quality of life as the basis of the social safety. Moscow: Gardariki; 2006 (in Russian).

3. Ovcharenko S.I., Akulova M.N. An assessment of a combined inhaled drug in treatment of asthma in relation to the duration of the disease. Terapevticheskiy arkhiv. 2009; 81 (3): 36–39. (in Russian).

4. Juniper E.F., Norman G.R., Cox F.M., Roberts J.N. Comparison of the standard gamble, rating scale, AQLQ and SF-36 for measuring quality of life in asthma. Eur. Respir. J. 2001; 18 (1): 38–44.

5. Senkevich N.Yu., Belevskiy A.S., Meshcheryakova N.N. Ways to improve the cooperativeness in patients with asthma. Atmosfera. Pul’monologiya i allergologiya. 2001; (0): 25–28. (in Russian).

6. Perel’man N.L. A relation between quality of life and the cooperativeness of patients with asthma. Byulleten’ fiziologii i patologii dykhaniya. 2012; (45): 19–23 (in Russian).

7. Lomper K., Chudiak A., Uchmanowicz I. et al. Effects of depression and anxiety on asthma-related quality of life. Pneumonol. Alergol. Pol. 2016; 84 (4): 212–221. DOI: 10.5603/PiAP.2016.0026.

8. Perel’man N.L. An influence of anxiety and depression on achievement control of asthma. Byulleten’ fiziologii i patologii dykhaniya. 2010; (37): 21–24 (in Russian).

9. Bosley C.M., Fosbury J.A., Cochrane G.M. The psychological factors associated with poor compliance with treatment in asthma. Eur. Respir. J. 1995; 8 (6): 899–904.

10. Tohda Y., Iwanaga T., Sano H. et al. Improved quality of life in asthma patients under long-term therapy: Assessed by AHQ-Japan. Int. J. Clin. Pract. 2017; 71 (1): e12898. DOI: 10.1111/ijcp.12898.

11. Ovcharenko S.I., Smulevich A.B., Akulova M.N. The control of asthma: psychosomatic relations and personality disorders. Atmosfera. Pul’monologiya i allergologiya. 2009; (1): 22–25. (in Russian).

12. Perel’man N.L. Quality of life in patients with asthma as a factor predicting the control of the disease. Byulleten’ fiziologii i patologii dykhaniya. 2009; (33): 30–33 (in Russian).

13. Perelman N.L. Seasonal differences of quality of life in asthmatics with cold airway hyperresponsiveness. Eur. Respir. J. 2009; 34 (Suppl. 53): 551s–552s.

14. Ware J.E. SF-36 Health Survey. Manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1997.

15. Juniper E.F., Buist A.S., Cox F.M. et al. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest. 1999; 115 (5): 1265–1270. DOI: 10.1378/chest.115.5.1265.

16. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr. Scand. 1983; 67 (6): 361–370. DOI: 10.1111/j.1600-0447.1983.tb09716.x.

17. Prikhod’ko A.G., Perel’man Yu.M., Kolosov V.P. Bronchial hyperreactivity. Vladivostok: Dal’nauka; 2011 (in Russian).

18. World Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013; 310 (20): 2191–2194. DOI: 10.1001/jama.2013.281053.

19. Rittmannsberger H., Pachinger T., Keppelmuller P., Wancata J. Medication adherence among psychotic patients before admission to inpatient treatment. Psychiatr. Serv. 2004; 55 (2): 174–179. DOI: 10.1176/appi.ps.55.2.174.

20. Ovcharenko S., Drobizhev M., Akulova M. et al. Cooperation between a physician and a patient (cooperativeness) and the course of the disease (in a model of bronchial asthma). Vrach. 2006; (12): 56–58. (in Russian).

21. Lavoie K.L., Bacon S.L., Barone S. et al. What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both? Chest. 2006; 130 (4): 1039–1047. DOI: 10.1378/chest.130.4.1039.