Original Article
Emotional quality-of-life and outcomes in adolescents with asthma

https://doi.org/10.1016/j.jpeds.2004.06.043Get rights and content

Objective

Examine the association between emotional quality-of-life (QOL) and asthma morbidity in adolescents with asthma.

Study design

Cross-sectional survey of 185 adolescents with asthma 11 to 17 years of age cared for in three managed care organizations (MCOs) in the United States. The asthma-specific Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and a short version of the generic Child Health and Illness Profile-Adolescent Edition (CHIP-AE) were used to assess emotional QOL. Asthma morbidity measures were: asthma control, emergency department (ED) visits, hospitalizations, doctor visits for worsening asthma, and missed school because of asthma.

Results

Of the adolescents surveyed, 45% reported feeling depressed, 41% had ED visits, and 30% missed ≥1 day of school because of asthma. Poorer asthma-specific emotional QOL was associated with poorer control of asthma symptoms (P < .0001), missed school (OR 7.1, P < .05), and doctor visits for worsened asthma (OR = 7.0, P < .05).

Conclusions

Emotional symptoms related to asthma are common in adolescents with persistent asthma and asthma-specific QOL is related to increased asthma morbidity, healthcare use, and school absenteeism. Adolescents with high morbidity from asthma exhibit poorer QOL. Therefore, the evaluation of asthma-specific emotional QOL should be included in the assessment of adolescents with asthma.

Section snippets

Study design

Data were collected as part of a study to evaluate asthma and asthma care for 5- to 17-year-olds in three managed care organizations that volunteered to participate in the study.17 The current report focuses on adolescents 11 to 17 years of age. The study employed a cross-sectional survey of parents of children with asthma. Part of the survey also was completed by the child if he/she was ≥11 years of age. The study was approved by the Committee on Human Research of the Johns Hopkins Bloomberg

Demographics and asthma morbidity (Table I)

Of 464 eligible adolescents identified by the MCOs, 185 completed the survey (40%; parent completion rate was 41.3%). At the two MCOs that provided such information, parent participation was higher among those with male children than among those with female children (50.8% vs 40.2% and 64.1% vs 56.2%). At the one MCO that provided information on types of plans offered, those enrolled in point-of-service plans were less likely to participate in the study than those in health maintenance

Conclusions

In this study of adolescents enrolled in MCOs and mostly with persistent asthma, poor emotional QOL (such as feelings of worry or anger because of asthma) was common. This study shows how emotional QOL relates to hospitalizations, ED visits, missed school, or doctor visits for worsening asthma in adolescents with asthma. Adolescents reporting worse asthma-specific emotional QOL reported more frequent school absence and doctor visits for asthma. Also, poorer asthma-specific emotional QOL was

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    Dr Okelo was supported by grants from the National Institute of Environmental Health Science (P50 ES 09609.03), the Environmental Protection Agency (R826724.03), and by the National Heart, Lung, and Blood Institute training grant (2 T32 HL07534). Dr Diette was supported by grants from the National Institutes of Health (HL04266 and ES009606) and the Environmental Protection Agency (R8267240). Dr Krishnan was supported by the Parker B. Francis Foundation and the National Institutes of Health (HL67850). Supported by a contract from Merck & Co., Inc.

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