The Prevalence and Patient’s Quality of Life for Asthma in Taiwan-Juniper publishers
JUNIPER PUBLISHERS-OPEN ACCESS INTERNATIONAL JOURNAL OF PULMONARY & RESPIRATORY SCIENCES
Abstract
Asthma affects approximately 5% of the population in
Taiwan. The increasing prevalence has caused concerns for both general
public and healthcare professionals. This study aims to understand
patients’ quality of life in order to provide guidance for appropriate
healthcare service as well as prevention. Face-to-face interview was
conducted using Asthma Quality of Life Questionnaire (AQLQ) in a
community hospital in northern Taiwan. A total of 106 questionnaires
were collected. The results indicate that patients concern mostly about
environmental stimuli which causes the greatest worries in the four
functions of AQLQ. Middle aged patients have the worse quality of life
than other age group counterparts. This is largely due to the emotional
and physical stress as the result of the disease.
Asthma is a common chronic airway disease
characterized by partially or completely reversible airway obstruction
known as asthma attacks. The most common symptoms are coughing, dyspnea,
and chest tightness. The adverse outcomes associated with asthma could
lead to inability to work, hospitalization, disability, and morbidity.
The disease places a heavy burden on governments, health care systems,
patients, and their families. Worldwide estimates of the prevalence of
adult asthma vary widely, from 0.8% to 13.4% [1]. Ethnicity and
demographic and environmental factors may contribute to these diverse
variations. In Taiwan, the prevalence rate of Asthma is estimated to be
5.1% [2] for general population. The prevalence rate can be doubled for
children. However, the severity of asthma increases after 18 years of
age and the mortality is high in the elderly [3]. The health care costs
for hospital outpatient visits, urgent visits and hospitalization in
adults with asthma are above 2 times of those without asthma [4]. Though
numerous studies have examined the epidemiology of asthma in Taiwan
[5], studies of the patients’ quality of life are scant.
Thus, this study investigates patients’
health-related quality of life employing The Asthma Quality of Life
Questionnaire (AQLQ) developed by Juniper et al. [6] to understand
patients’ suffering from the disease.
Face-to-face interviews were conducted in a northern
Taiwan community hospital. The inclusion criteria are 1. presence of
symptoms of airflow obstruction (cough, wheezing, dyspnea), 2. Airflow
obstruction is at least partially reversible (demonstrated by
spiromentry at any time - FEV1 increased by >15% following β-agonist
inhalation) or evidence of bronchial hyper responsiveness by metacholine
challenge (demonstrated by PC20<8μg), 3. Age is 18 years or older.
Patients’ obstructions involving large airways (such as foreign body in
trachea or bronchus, vocal cord dysfunction, vascular rings or laryngeal
webs, laryngotracheomalacia, tracheal stenosis or bronchostenosis,
enlarged lymph nodes or tumor) or small airways (such as viral
bronchiolitis or obliterative bronchiolitis, cystic fibrosis,
bronchopulmonary dysplasia) and other causes such as drug induced
symptoms or aspiration from swallowing mechanism dysfunction are
excluded from the study.
There are 32 questions in the four domains (symptoms,
activity limitation, emotional function and environmental stimuli) of
AQLQ. The activity domain contains 5 ‘patient-specific’ questions. This
allows patients to select 5 activities in which they are most limited
and these activities will be assessed at each follow-up. Patients are
asked to think about how they have been during the previous two weeks
and to respond to
each of the 32 questions on a 7-point scale (7 = not impaired
at all, and 1 = severely impaired). The overall AQLQ score is the
mean of all 32 responses and the individual domain scores are
the means of the items in those domains. Thus, AQLQ has scores
range 1-7, with higher scores indicating better quality of life.
The validity of AQLQ was established by comparison to
conventional clinical asthma measures (symptoms, peak flow
rates, medication use, PFT, airway responsiveness, global rating
of asthma), generic HRQL measures (Rand; SIP) [7] clinical
sensibility of the measure [8]; symptoms & clinical efficacy [9].
The data collection period was from February 2013
to February 2014. All the patients were referred to the
interviewers by their physicians from the pulmonary clinics at
a local community hospital in Northern Taiwan. The physicians
explained the study purpose to the patients before referring them
to the interviewers. If the patients were not willing to accept
the interview then the physician would respect their decision.
This study was approved by the IRB board of the hospital.
Written informed consent was obtained from all participants
before conducting the interview. Patients who did not know
their diagnosis were not referred to us by their physician and
consequently were not recruited into this study interview.
To control the quality of the interviews, all
researchinterviewers participated in a 2-3 h training program and
received a detailed training document that delineated the study
purpose, language to be used, interview procedure and coding
book.
Since the physicians explained the study purpose to the
patients before referring them to the interviewers, the response
rate of the study was fairly high. Around 123 patients were
invited to take part and 106 of them answered the questions.
Written informed consent was obtained from all participants
before conducting the interviews. Patients who did not know
their diagnosis were not referred to us by their physicians and
consequently were not recruited. Patients with very severe
symptoms would go to medical center for treatment. Thus this
study comprise the subject with not-so-severely ill asthma
patients at the time of interview.
The Patients Background
The average age (±SD) of our subjects is 58.48 (±17.01) years old with the oldest patient 85 years old and the youngest one 19 years of age. About 72% of the subjects are diagnosed with asthma for less than 10 years and around 10% are diagnosed with asthma from 10 to 20 years. 40.7% of the subjects are cigarette smokers, and 24% of them received only primary school education. 27% of the subjects reported to have severe disease condition, 24% reported to be moderate condition, and only 9% to be mild.Results of AQLQ
The results of QOL (quality of life) scores and the ANOVA
analysis across groups are reported in Table 1. Notably, the
age group of 30-39 and patients with disease year 11-20 have
the lowest overall QOL. Cigarette smoking behavior does not
affect patients’ overall QOL. But patients with cigarette smoking
behavior are lot more susceptible to environmental stimuli than
non-cigarette smokers, reflected by low QOL smokers.
Table 2 presents the relative importance for different
functions. Among the four functions, activity limitation received
the highest average score while environmental stimuli received
the lowest, indicating that environmental quality caused the
greatest concern for the patients. Patients are concerned about
cigarette smoke around them and would do their best to avoid it.
Though the function of activity limitation received a high score
for patients’ quality of life, the concern about the loss in activity
due to asthma is substantial, which received the lowest score in
the questionnaire.
Reliability test
Finally, the reliability test was performed by Cronbach’s
Alpha and the results exhibited high internal consistency as
shown in Table 3.
An increasing prevalence rate of asthma in Taiwan has
drawn attention to general population as well as health
authority. Patients’ health-related quality of life is of concern
for both patients’ family and healthcare personnel for providing
better services. The result of this study indicates that patients
worry mostly about the environmental condition and stimuli
such as cigarette smoke that may cause uncomfortableness both
emotionally and physically. Patients in the middle age group has
the lowest QOL compared to younger and order counterparts.
This is probably because that the patients in this age group
takes main responsibility in the family and hence are under
great emotional stress about physical impairments. Activity
limitation is of less concern among the four functions in the AQLQ questionnaire. However, the worries and fear for further
impairments are the major reason for low QOL. This research
is done in a community hospital in norther Taiwan where not
the patients with most severe conditions go. An overestimate
of patients’ QOL is possible. Nonetheless, this paper provides
an overall understanding about how asthma patients might feel
in Taiwan. A good measure of environmental avoidance should
be propagandized in order to alleviate patients’ suffering both
emotionally and physically.
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