Scale for assessing functional impairment in adults with asthma

Insomnia and Daily Function in Older Adults With Asthma

The current study examined the prevalence of insomnia and its relationship with daily function in older adults with asthma. Data on 278 older adults with asthma (aged ≥60 years) from the 2005-2008 National Health and Nutrition Examination Survey were analyzed. Insomnia was present in 40% of the study sample and was associated with a greater number of activities of daily living (ADL) and instrumental ADL (IADL) limitations. In multivariate analyses accounting for covariates including depressive symptoms, insomnia was not associated with having at least two ADL/IADL limitations. However, those with co-occurring insomnia and depressive symptoms were more likely to have at least two ADL/IADL limitations compared to those with either condition singly. Insomnia in the presence of depressive symptoms may impede one's ability to perform ADL/IADL. Current findings suggest that assessment and treatment of insomnia and depression in older adults with asthma may be important for maintaining active, independent living. [Journal of Gerontological Nursing, 46(11), 28-36.].

Associations Between Asthma Control and Airway Obstruction and Performance of Activities of Daily Living in Older Adults with Asthma

OBJECTIVES

To determine the effect of asthma on functional limitations of older adults in the United States.

DESIGN

Analyses were conducted with data from the Asthma Beliefs and Literacy in the Elderly study, a prospective cohort study of people aged 60 and older with asthma.

SETTING

Participants were recruited from urban primary care and pulmonary specialty practices in New York City and Chicago between 2010 and 2012.

PARTICIPANTS

Individuals aged 60 and older with asthma (380 women, 72 men, mean age 67.5 ± 6.8 (range 60-98), 40% Latino, 30% black).

MEASUREMENTS

Characteristics of participants with and without activity of daily living (ADL) limitations were compared using the chi-square test. Generalized estimating equations were used to model the relationships between poor asthma control (Asthma Control Questionnaire (ACQ) score >1.5) and severity of airway obstruction (forced expiratory volume in 1-second (FEV1 )) and number of ADL limitations.

RESULTS

Participants with one or more ADL limitations were more likely to be female (90% vs 81%, P = .02) and Latino (58% vs 32%, P < .001), have less than a high school education (53% vs 27%, P < .001) and an income of $1,350 per month or less (79% vs 46%, P < .001), and be unmarried (78% vs 64%, P = .003). In the adjusted analysis, poorer ACQ scores (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.0-2.4; P = .05) but not severity of airway obstruction (OR = 1.1, 95% CI = 0.6-1.9) was associated with greater ADL limitations.

CONCLUSION

Older adults reporting poor asthma control are more likely to have ADL limitations than those with controlled asthma, although one-time spirometry may not adequately identify those at risk of physical impairment from asthma.

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 (beta = -0.70). Asthma control and symptom distress were indirectly influencing QOL. Among the predictors, direct paths were found between asthma control and functioning (gamma = 0.20), and between symptom distress and functioning (gamma = 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.

Performance of valued life activities reflected asthma-specific quality of life more than general physical function

OBJECTIVE

We examined the prevalence of disability in valued life activities (VLAs) among a group of adults with asthma and the impact of general physical function and performance of VLAs on asthma-specific quality of life (QOL).

STUDY DESIGN AND SETTING

Interview data collected from two waves of a longitudinal cohort study were used to examine the prevalence of disability in VLAs, the cross-sectional association of general function and performance of VLAs with QOL, and the longitudinal association of changes in general function and changes in performance of VLAs with changes in QOL. General function was assessed with the SF-12; VLAs were assessed with a newly developed measure.

RESULTS

A substantial portion of subjects reported disability in VLAs. VLA function was a stronger predictor of QOL than general physical function in cross-sectional and longitudinal analyses.

CONCLUSION

Performance of VLAs is more closely tied to asthma-specific QOL than is general physical function.

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.

Comparing discriminative validity between a disease-specific and a general health scale in patients with moderate asthma

Health-related quality of life scales such as the Asthma Quality of Life Questionnaire and the Medical Outcomes Study Short-form General Health Survey SF-36 have become important measures of health status in clinical asthma trials. The discriminative properties of these scales, however, have not been extensively evaluated and compared. The purposes of this study were to assess and compare scale and discriminative properties of the Asthma Quality of Life Questionnaire (AQLQ) and the SF-36 in a group of patients with moderate asthma using a patient-rated global measure of disease activity as the criterion variable. Patients were interviewed in-person with a series of questionnaires including the AQLQ and the SF-36, and were also asked the global question "How active is your asthma now?" with possible responses of "extremely," "very," "moderately," "mildly" or "not active." Discriminative properties were determined using receiver operating characteristic (ROC) curves with responses to the global question as the criterion variable and mean domain scale scores as the independent variables. Relative validities for the AQLQ and SF-36 domains were also compared. A total of 230 patients, mean age of 41 years, were enrolled. Scores were lower and ranges were narrower for the AQLQ compared to the SF-36. In general, the AQLQ and the SF-36 were highly correlated, with r = 0.69 for the AQLQ overall score and the SF-36 Physical Component Summary (PCS) score. According to ROC analyses, both scales had excellent discriminative properties; however the area under the ROC curve was higher for the AQLQ overall score (0.81) than for the PCS (0.75). When ranked according to ROC area, the symptoms domain (0.83) had the greatest area under the ROC curve, followed by the emotional (0.76) and activities (0.76) domains of the AQLQ. However, in some cases, the area under the curve was less for an AQLQ domain (for example, 0.71 for the environmental domain) than for SF-36 domains (for example, 0.75 for the role physical, and 0.75 for the social domain). Similarly, the AQLQ overall had a higher relative validity (5.2) compared to the PCS (2.2), and the symptoms domain of the AQLQ had the highest relative validity (6.0). Thus, both the Asthma Quality of Life Questionnaire and the SF-36 were able to characterize patients with moderate asthma in our cross-sectional study. In addition, both scales had strong discriminative properties when assessed with a global patient rating of current disease activity.

Effects of depressive symptoms on health-related quality of life in asthma patients

OBJECTIVE

To assess the effects of depressive symptoms on asthma patients' reports of functional status and health-related quality of life.

DESIGN

Cross-sectional study.

SETTING

Primary care internal medicine practice at a tertiary care center in New York City.

PATIENTS

We studied 230 outpatients between the ages of 18 and 62 years with moderate asthma.

MEASUREMENTS AND MAIN RESULTS

Patients were interviewed in person in English or Spanish with two health-related quality-of-life measures, the disease-specific Asthma Quality of Life Questionnaire (AQLQ) (possible score range, 1 to 7; higher scores reflect better function) and the generic Medical Outcomes Study SF-36 (general population mean is 50 for both the Physical Component Summary [PCS] score and Mental Component Summary [MCS] score). Patients also completed a screen for depressive symptoms, the Geriatric Depression Scale (GDS), and a global question regarding current disease activity. Stepwise multivariate analyses were conducted with the AQLQ and SF-36 scores as the dependent variables and depressive symptoms, comorbidity, asthma, and demographic characteristics as independent variables. The mean age of patients was 41 +/- SD 11 years and 83% were women. The mean GDS score was 11 +/- SD 8 (possible range, 0 to 30; higher scores reflect more depressive symptoms), and a large percentage of patients, 45%, scored above the threshold considered positive for depression screening. Compared with patients with a negative screen for depressive symptoms, patients with a positive screen had worse composite AQLQ scores (3.9 +/- SD 1.3 vs 2.8 +/- SD 0.8, P <.0001) and worse PCS scores (40 +/- SD 11 vs 34 +/- SD 8, P <.0001) and worse MCS scores (48 +/- SD 11 vs 32 +/- SD 10, P <.0001) scores. In stepwise analyses, current asthma activity and GDS scores had the greatest effects on patient-reported health-related quality of life, accounting for 36% and 11% of the variance, respectively, for the composite AQLQ, and 11% and 38% of the variance, respectively, for the MCS in multivariate analyses.

CONCLUSIONS

Nearly half of asthma patients in this study had a positive screen for depressive symptoms. Asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity but fewer depressive symptoms. Given the new emphasis on functional status and health-related quality of life measured by disease-specific and general health scales, we conclude that psychological status indicators should also be considered when patient-derived measures are used to assess outcomes in asthma.

Psychometric performance of the Asthma Quality of Life Questionnaire in a US sample

The purpose of this study was to examine the psychometric characteristics of the Juniper Asthma Quality of Life Questionnaire (AQLQ) in a sample of asthmatics from the USA, employing data from the Asthma Symptom Utility Index (ASUI) validation study. One hundred and sixty-one adults (66 men) undergoing standard care in an asthma clinic participated in the study (mean age = 34.7 +/- 10.7 years, mean duration of illness = 17.3 +/- 11.22 years and mean FEV1% predicted = 85.6% +/- 17.1%). The internal consistency reliability (infinity) ranged from 0.90 (environment subscale) to 0.95 (overall score) and the 2 week reproducibility (ICC) ranged from 0.81 (activities subscale) to 0.93 (symptoms subscale). The AQLQ was significantly correlated with an asthma disease severity scale and the Health Utilities Index (p < 0.001). No relationship was found between the AQLQ score and FEV1% predicted. Men reported better overall quality of life (QoL), fewer activity limitations and less environmental exposure than women (p < 0.01), while patients with a high school education or less had more severe asthma and poorer QoL across all subscales (p < 0.001). This may reflect the differential experiences of asthma across gender and socioeconomic groups. The results suggest that the AQLQ may be a useful outcome measure for clinical trials conducted in the USA.