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Title: The level of quality of life in children with astma – the impact ofclinical factors and nutritional status

Abstract:

Introduction In recent years, there has been observed a rapid increment in theincidence of asthma and obesity. Both of these diseases, as aconsequence of their common occurrence, generate problems in thebio – psycho – social areas, which are reflected in the quality of life ofthe children suffering from them.Therefore, asthma and obesity are now seen as some of the majorhealth and social problems in developing countries. Further studiesare needed to allow for the early identification of the risk factorsworsening the course of these two diseases. The evaluation of thevarious areas of the quality of life can contribute to an individual,therapeutic approach to children with asthma and associated obesity.The purpose of the studyThe purpose of the study in children with asthma, was to assess andcompare the quality of life and its domains according to theirnutritional status and to determine the clinical factors that havesignificant impact on quality of life among the patients.Materials and methodThe study included 59 children aged 8-17, patients of the PulmonaryClinic of the University Children's Hospital in Krakow. The patientsunderwent 12 weeks’ observation in the course of 4 visits. Thefollowing surveys were made for each patient: 1) Paediatric AsthmaQuality of Life Questionnaire with Standardized Activities (PAQLQ(S)), 2) Asthma Control Questionnaire - the last week, 3) AsthmaControl Test (ACT) – the last four weeks, 4) Questionnaire of AsthmaSymptoms – the last 12 months. The caregivers of children weretested with the following surveys: Paediatric Asthma CaregiverQuality of Life Questionnaire (PACQLQ). In addition, the child wassubject to a physical capacity test and respiratory function testincluding an assessment of bronchial hyperresponsiveness. Basing onthe classification of nutritional status using the BMI, children with ; asthma were included in the following groups: group I – children withnormal weight /underweight, group II – children with overweight/obesity.ResultsIn nearly ⅔ of the children, there was found a mild persistent asthma,including the clinical course of the disease and the treatment level.Between group I and II, no statistically significant differences wereobserved in the clinical characteristics, except for the parameters ofweight and BMI. There were no statistically significant differencesbetween the groups in quality of life as well as in any of its domains.A comparable contribution of different domains in composition of thequality of life was demonstrated in children in group I and group II.There was no significant relationship between the quality of life inchildren in group I and group II, and: sex, age, asthma severity, thetreatment steps.There were no significant differences in the course of asthma betweenthe two analyzed groups during the last week. However, there was astatistically significant correlation of the degree of physical activitylimitation and indicator of the quality of life in group I, there wasborder line statistical significance in group II.There was no significant difference in the incidence of individualsymptoms assessed in the ACT test (during the past 4 weeks) betweenthe analyzed groups. Likewise, there was no statistically significantdifference observed in the assessment of the level of asthma control,calculated on the basis of ACT scores in the two groups. Regressionanalysis indicated no participation of ACT test scores, nor anysymptoms included in this test, with the level of quality of life inchildren of the two groups.The following analysis of the incidence of asthma symptoms in thepast 12 months did not reveal any significant differences, except forthe presence of exacerbations during this time period. Theseexacerbations occurred significantly more often in group I than ingroup II. Subsequent univariate regression analysis indicated asignificant relationship between the fact of asthmatic physical activitylimitation and quality of life in children only in group II. Moreover, in ; this group there was observed negative correlation of the quality oflife and the frequency of daytime symptoms. However, in group I,there was a significant relationship between the frequency of use ofβ2-agonist in the last year and the quality of life. Subjectiveassessment of asthma control in this period expressed by the child andthe caregiver did not affect the level of quality of life in any of thetested groups.In further analyzes, there were no statistically significant differencesbetween groups I and II in quantitative and qualitative evaluation ofphysical capacity. In addition, univariate regression showed nosignificant correlation between the quality of life of children in eachgroup and the parameters of pulmonary function tests (FEV1, PEFR,D% FEV1, D%PEFR), nor physical capacity determinedquantitatively (Ww) or qualitatively.Subsequent assessment of the relationships between different asthmasymptoms (in the last: week, month, year) and quality of life ofchildren, using multivariate regression analysis, identified asimportant factors: the frequency of asthma symptoms and thefrequency of use of β2-agonists, but only for the period of the lastyear.In caregivers of the children in group I and group II, there were nosignificant differences in comparing their quality of life, taking intoaccount its particular domains based on the questionnaire PACQLQ(questionnaire designed for the child's parents).There was no significant correlation of the quality of life of parentsand child’s: gender, age, severity level of asthma, and the level ofasthma treatment. Subsequent univariate regression analyses of therelationships between quality of life of the parents of children in eachgroup and: asthma symptoms in their children in the last week, lastyear; the parameters of pulmonary function tests; physical capacity –did not show a distinct direction. Whereas in multivariate regressionanalysis it was found that only subjective assessment of asthmacontrol in the last year and the assessment of asthma control based onthe symptoms in the last year in the studied children is related withdifferent strength to the quality of life of their parents. ; Moreover, in the present study, there were observed significantdifferences between the quality of life level of caregivers and thequality of life level of the studied children. The analysis of thedomains compounds showed that the difference occurs due to asignificant change only in the emotional functioning domain in bothgroups.In the next phase of the study the quality of life was evaluated in theperiod of 3 months at intervals of 4 weeks. There was a significantincrease in the quality of life level and all its domains in asthmaticchildren between the first and the last visit. Moreover, there was asimilar increase in the quality of life level in the parents of the studiedchildren between these visits. However, within the domains of theparents, only the emotional functioning domain showed a significantchange. The observed increase in the quality of life of children andparents in this 3 – month period of observation was not accompaniedby an improvement in: the values of the parameters of pulmonaryfunction tests, bronchial hyperresponsiveness, physical capacity, levelof asthma control in the 4 weeks period, asthma symptoms in the lastweek, except for significantly less frequent use of β2-agonists in thelast week.Conclusions1. The quality of life in asthmatic children with obesity andoverweight is no different from the quality of life of asthmaticchildren with normal nutritional status.2. The quality of life of caregivers of asthmatic children with obesityand overweight is no different from the quality of life of caregivers ofasthmatic children with normal nutritional status.3. There is a significant difference in quality of life betweencaregivers and the quality of life of the studied children.4. There was no consistent significant correlation between the qualityof life of asthmatic children and the quality of life of their caregivers,and: child’s gender, age, the disease severity, the treatment level,pulmonary function test parameters and bronchialhyperresponsiveness, and asthma symptoms in short periods of time(last week, last month), including children’s nutritional status ; differentiation. In both children groups, there was a significant,variable relationship between their quality of life level and itsdomains and the presence of asthmatic symptoms and the use ofreliever medications in the long-term assessment (last year).5. There was showed a trend of improvement of the quality of life ofasthmatic children and their caregivers during the 3-monthobservation, with no significant change in: asthma symptoms,pulmonary function parameters, or bronchial hyperresponsivenessduring that time.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

pediatria

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Grzegorz Lis

Date issued:

2013

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3679

Call number:

ZB-120492

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

Jun 26, 2019

In our library since:

Apr 18, 2014

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