Role of psychological factors and asthma control in asthma quality of life
Published online: July 18, 2019
Asthma can affect patients’ quality of life (QoL), limiting their functional capacity, physical and social activities and negatively affecting their emotional state, but the degree to which this chronic disease influences QoL depends on multiple factors. Psychological variables (anxiety, depression and coping strategies used by the patient to deal with the stressful situations) and control level of asthmatic symptoms (assessed from the patient’s perspective or from the physician’s perspective) are associated with asthmatic patient QoL. However, to date, no study had simultaneously evaluated these variables to understand the extent to which each of those factors contribute independently to QoL.
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, González-Freire and co-authors analyzed concurrently the impact of anxiety, depression, coping strategies, and asthma control on generic and specific domains of QoL in asthmatic patients, and they compared the impact of asthma control on QoL when it is established by the physician versus when it is considered by the patient. The authors enrolled 373 outpatients with asthma in a tertiary center in Spain who completed the following questionnaires: Hospital Anxiety and Depression Scale, Coping Orientations to Problems Experienced Inventory, Asthma Control Test, 36-Item Short-Form Health Survey (a generic questionnaire that allows the evaluation of dimensions of quality of life common to populations with different diseases and general population), and the St. George’s Respiratory Questionnaire (a specific questionnaire sensitives to respiratory patients’ specific problematic). Physicians recorded asthma control according to clinical and pulmonary function parameters. Demographic and clinical characteristics were also collected.
This study revealed that all of the psychological and asthma control variables evaluated are independent predictors of asthma QoL, but the main variables are anxiety, depression and patient-rated asthma control. These variables were associated with worse generic and specific QoL in physical, social, emotional and functional dimensions. The impact of physician-rated control and coping strategies on QoL is lower. Physician-rated asthma control was related to worse QoL in physical generic and disease-specific domains. Among the coping strategies, only avoidant coping (characterized by the effort to avoid dealing with stressful situations) impacted QoL in a few dimensions.
In summary, the results of this study show that, although they are interrelated concepts, anxiety, depression, coping strategies and asthma control contribute independently to QoL. Therefore, all of them should be taken into account when considering QoL scores as an outcome measure in asthma. Since anxiety, depression and asthma control estimated by the patient were the most important independent predictors of asthma QoL, the authors suggest that these variables should be routinely screened in asthmatic patients and, in cases where it is necessary, interventions focused on these potentially modifiable factors should be implemented to improve QoL in asthmatic patients.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.