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Asthma quality of life in a Southern practice: towards a new paradigm
Background:
Quality of life (QOL) surveys are increasingly recognized as part of state-of-the-art asthma assessment. Disease-specific surveys quantitate total QOL and subscale domains which, along with changes in these measures, suggest asthma severity and effects of intervention.
Objectives:
This study was conducted to (1) compare regional variation in QOL and change in QOL in an allergy practice in the South and (2) to examine if one or a set of questions relating to asthma severity could estimate QOL thereby obviating the need for a complete survey.
Methods:
Fifty-eight patients were administered an asthma specific quality of life (AQOL) questionnaire, the Marks et al Asthma Quality of Life survey, at baseline and surveyed in follow-up at 1 and 6 months. Additional questions were asked concerning bronchodilator use in a day and 1 week, missed work/school days, nocturnal wakening in 1 week due to asthma, emergency room visits in the previous month, and past hospitalizations in the last year. Spirometry was performed at each visit.
Results:
Baseline AQOL is significantly (P < .05) related individually to nocturnal wakening, bronchodilator use in a day, work or school days missed, and hospitalization during the past year. A model combining these factors explains 49% of the variance, r2 = .49. The AQOL score between baseline and the first month shows a significant improvement (P < .0001) and this improvement is related (P = .002) to the reduction in nocturnal wakenings during that same time period.
Conclusions:
Specialty care intervention affected QOL similarly in the Southern practice compared with other regions/countries. Nocturnal wakening, bronchodilator use in a day, workdays missed, and hospitalization in the past year were all significantly correlated with AQOL. Number of nocturnal wakenings and bronchodilator use in a day may not only stratify asthma severity, they roughly stratify AQOL. The wide scatter of AQOL scores for a given indicator of asthma severity makes a limited combination of questions an indicator but not yet a reliable predictor of AQOL.