Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma

Allan T Luskin; Bradley E Chipps; Lawrence Rasouliyan; Dave P Miller; Tmirah Haselkorn; Alejandro Dorenbaum

doi:10.1016/j.jaip.2014.02.011

Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma

J Allergy Clin Immunol Pract. 2014 Sep-Oct;2(5):544-52.e1-2. doi: 10.1016/j.jaip.2014.02.011. Epub 2014 Jul 3.

Authors

Allan T Luskin¹, Bradley E Chipps², Lawrence Rasouliyan³, Dave P Miller³, Tmirah Haselkorn⁴, Alejandro Dorenbaum⁵

Affiliations

¹ Department of Medicine, University of Wisconsin, Madison, Wis. Electronic address: allan_luskin@hotmail.com.
² Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
³ Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif.
⁴ US Medical Affairs, Genentech, Inc., South San Francisco, Calif.
⁵ Department of Pediatric Immunology and Allergy, Stanford University School of Medicine, Stanford, Calif.

PMID: 25213047
DOI: 10.1016/j.jaip.2014.02.011

Abstract

Background: Few data are available that evaluate the relationship among asthma exacerbations, asthma triggers, and asthma-related quality of life (QoL).

Objective: To evaluate the impact of asthma exacerbations and asthma triggers on QoL.

Methods: Patients with severe or difficult-to-treat asthma, ages ≥ 13 years (n = 2679) from the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) 3-year observational study were included. Exacerbations were defined hierarchically in descending order of severity (hospitalization, emergency department [ED] visit, steroid burst, no exacerbation) by using data from months 6 and 12. The total number (frequency) of exacerbations was assessed. Asthma-related QoL was measured at month 12 by using the Mini-Asthma QoL Questionnaire (Mini-AQLQ); self-reported asthma triggers were collected at baseline and annually. We used 1-way ANOVA to test for differences in Mini-AQLQ domain scores across asthma exacerbation severity, the total number of asthma exacerbations, and the number of asthma triggers.

Results: A significant decrease (P < .001) in Mini-AQLQ domain scores was seen with increasing severity of asthma exacerbation (no exacerbation, steroid burst, ED visit, and hospitalization); symptom (5.5, 4.8, 4.3, and 4.2), activity (5.8, 5.2, 4.6, and 4.4), emotional (5.6, 5.0, 4.4, and 4.2), exposure (5.0, 4.5, 4.0, and 3.9); and overall (5.5, 4.9, 4.3, and 4.1). Increasing exacerbation frequency and the number of baseline asthma triggers also were associated with significant decreases in Mini-AQLQ domain scores. An increasing number of asthma triggers were associated with an increase in severity and frequency of exacerbations.

Conclusion: Avoidance of asthma triggers may reduce exacerbation rates and improve asthma-related QoL in patients with severe or difficult-to-treat asthma. Interventional studies are warranted to further explore these outcomes.

Keywords: Allergic triggers; Difficult-to-treat asthma; Quality-of-life; Severe asthma.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Asthma / epidemiology*
Asthma / etiology*
Asthma / psychology
Cohort Studies
Emergency Service, Hospital / statistics & numerical data
Female
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Quality of Life
Self Report
Severity of Illness Index
Surveys and Questionnaires
Young Adult