Dissertations / Theses on the topic 'Quality of life of patients with bronchial asthma'

Aim: It was the aim of the present study to investigate in detail and at length the experience of quality in a life with asthma, within the perspective of those suffering from the disease rather than those with a professional interest in it. Method: An ethnographic method was adopted, consisting of three semi-structured interviews with a sample of 22 moderately severe asthma patients referred to consultant respiratory physicians in Aberdeen, Scotland. Potential interviewees, stratified by age, sex and social class, were invited to participate after they had completed their year in the Grampian Asthma Study of Integrated Care (GRAS SIC 1994a). After a minimum delay of eight months following their exit from GRAS SIC, interviews were conducted in their homes, were audio recorded, selectively transcribed, and subjected to content analysis. Conclusions and implications: Identifying quality of life with asthma as an existential concept aesthetically understood and therefore unpredictably variable has serious implications for its use in clinical practice, health care planning and purchasing, and research. Professional judgements about the outcome of treatment for individual asthma patients should incorporate that patient's valuation of that outcome: what may to the professional be highly desirable treatment effects may be irrelevant to the person within whom they are observed. Similarly, planning and purchasing health care for asthma on the basis of data which do not incorporate the value judgements of the users of services may lead to the provision of insignificant levels and types of care for specific communities and a failure to provide care or services for which the community has a true value. Each of these effects derives from the difficulty of validly measuring so unstable an outcome. Research into quality of life should concentrate upon the task of devising outcome measurement methods which directly, accurately and meaningfully incorporate patient-held values. The difficulty of doing so should not be underestimated. A clear distinction should be drawn between methods which measure an aspect (or aspects) of health status and those which reflect quality of life. These two concepts are not identical, and care should be taken that the terms are used independently, specifically and without ambiguity. Health status describes the physical, mental or social functioning of the individual within their condition or state. To use health status measures to validate assessment of life quality is to misconceive the nature of their relationship. Quality of life refers to the all-embracing subjective value of the human condition.

L'objectiu general d'aquesta tesi doctoral va ser avaluar la qualitat de vida relacionada amb la salut (QVRS) en pacients amb asma i els factors sociodemogràfics i clínics que contribueïxen al seu deteriorament. També, avaluar la seguretat dels broncodilatadors d'acció llarga (BAL) combinats amb corticosteroides inhalats (CI) i els determinants de l'adherència al tractament. L’evidència obtinguda en estudis observacionals (recerca sistemàtica en MEDLINE i EMBASE, període 1990-2013, incloent 19 estudis amb graandàries mostrals entre 50 i 514.216), mostren que el tractament combinat de LABA i CI no està associat a un major risc d'esdeveniments adversos greus, en comparació amb només CI. Els principals dèficits identificats van ser la mancança de disseny prospectiu, de població pediàtrica i de inclusió de la mortalitat com a resultat primari. Una revisió sistemàtica dels estudis observacionals sobre els determinants de l'adherència als inhaladors per a l‘asma va identificar 51 estudis (cerca realitzada a EMBASE, Medline, PsychInfo i PsychArticles de 1990 a 2014) que van examinar principalment els factors relacionats amb el pacient, i van trobar associacions consistents entre l’adherència i creences més arralades en la necessitat dels inhaladors, i possiblement amb una edat més avançada. Es va detectar la necessitat d'una amplia adopció d'estàndards conceptuals i metodològics comuns. El projecte titulat “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) va ser un estudi prospectiu longitudinal (n = 908 pacients). Els pacients es van reclutar en els centres d’atenció primària a França i el Regne Unit. Els criteris d'inclusió eren: individus de 6 a 40 anys d'edat amb asma persistent, definit com més de 6 mesos de prescripció de CI i/o BAL durant els 12 mesos previs al seu reclutament. L'anàlisi dels 290 pacients que van completar l'EQ-5D-5L en l'enquesta basal per internet va demostrar un efecte sostre acceptable, una bona validesa de constructe i una alta fiabilitat, donant suport a la idoneitat d'aquesta nova versió del EQ-5D per avaluar la QVRS en pacients amb asma. Finalment, vam comparar els pacients francesos (n = 222) amb les normes de referència EQ-5D procedents de França per estimar l'impacte de l'asma en la QVRS del pacient. L'asma persistent té un impacte moderadament negatiu en els pacients d'ambdós sexes, i les dones més joves van ser identificades com un grup d'alt risc que mereix més recerca. Hem identificat el control de l'asma com a principal factor associat de la reducció de la QVRS en els pacients, independentment del seu gènere, el que suggereix que l'impacte de l‘asma en la QVRS es podria mitigar aconseguint un bon control dels símptomes.
El objetivo general de esta tesis doctoral fue evaluar la calidad de vida relacionada con la salud (CVRS) en pacientes con asma y los factores sociodemográficos y clínicos que contribuyen a su deterioro. Asimismo, evaluar la seguridad de los broncodilatadores de acción larga (BAL) combinados con corticosteroides inhalados (CI) y los determinantes de la adherencia al tratamiento. La evidencia obtenida en los estudios observacionales (búsqueda sistemática en MEDLINE y EMBASE, período 1990-2013, incluyó 19 estudios de tamaños muestrales entre 50 y 514.216) demuestra que el tratamiento combinado de BAL y CI no se asocia con un mayor riesgo de eventos adversos graves, en comparación con el tratamiento sólo con CI. Los principales déficits identificados fueron la falta de diseño prospectivo, de población pediátrica y de mortalidad como resultado primario. La revisión sistemática de estudios observacionales sobre determinantes de la adherencia a los inhaladores para el asma identificó 51 estudios (búsqueda realizada en EMBASE, Medline, PsychInfo y PsychArticles entre 1990 y 2014) que examinaron principalmente los factores relacionados con el paciente y encontraron una relación consistente entre la adherencia y las creencias más arraigadas en la necesidad de inhaladores, y posiblemente con una edad más avanzada. Se detectó la necesidad de una adopción más amplia de estándares conceptuales y metodológicos comunes. El proyecto titulado “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) fue un estudio longitudinal prospectivo (n = 908 pacientes). Los pacientes fueron reclutados en centros de atención primaria en Francia y Reino Unido. Los criterios de inclusión fueron: individuos cuyas edades estaban comprendidas entre los 6 y 40 años con asma persistente, definido como más de 6 meses de prescripción de CI y/o BAL durante los 12 meses anteriores al reclutamiento. El análisis de los 290 pacientes que completaron el EQ-5D-5L en la encuesta basal por internet demostró un efecto techo aceptable, una buena validez de constructo y una alta fiabilidad, lo cual apoya la idoneidad de esta nueva versión del EQ-5D para evaluar la CVRS en pacientes con asma. Finalmente, comparamos los pacientes franceses (n = 222) con las normas de referencia del EQ-5D en Francia para estimar el impacto del asma en la CVRS de los pacientes. El asma persistente tiene un impacto en la CVRS moderadamente negativo en pacientes de ambos sexos, y las mujeres más jóvenes fueron identificadas como un grupo de alto riesgo que merece más investigación. Identificamos el control del asma como el principal factor asociado al deterioro de la CVRS en los pacientes, independientemente de su sexo, lo que sugiere que el impacto del asma en la CVRS se podría mitigar logrando un buen control de los síntomas.
The general aim of this doctoral thesis was to evaluate the health-related quality of life (HRQoL) in patients with asthma, and the socio-demographic and clinical factors which contributed to its impairment. Also, to assess the safety of long-acting beta-agonists (LABAs) combined with inhaled corticosteroids (ICs), and the determinants of treatment adherence. Evidence from observational studies (systematic search in MEDLINE and EMBASE, period 1990-2013, including 19 studies with sample sizes from 50 to 514,216) shows that the combined treatment of LABAs and ICs is not associated with a higher risk of serious adverse events, compared to ICs alone. Major gaps identified were: prospective design, paediatric population and inclusion of mortality as a primary outcome. The systematic review of observational studies on determinants of asthma inhaler adherence identified 51 studies (search performed in EMBASE, Medline, PsychInfo and PsychArticles from 1990 to 2014) which mainly examined patient-related factors and found consistent links between adherence and stronger beliefs in inhaler necessity, and possibly with older age. The need of a broader adoption of common conceptual and methodological standards was detected. The project entitled “Assessment of the Safety of LABAs in asthma in routine care by combining health care data bases and direct patient-follow-up” (ASTRO-LAB) was a prospective longitudinal study (n= 908 patients). Patients were enrolled in primary care in France and United Kingdom by their general practitioner. Inclusion criteria were: subjects aged 6-40 years old, with persistent asthma, defined as more than 6 months of prescribed ICs and/or LABAs during 12 months before inclusion. Analysis of the 290 patients who completed the EQ-5D-5L in the baseline online survey demonstrated acceptable ceiling effect, good construct validity, and high reliability, supporting the adequacy of this new EQ-5D version for assessing HRQoL in asthma patients. Finally, French patients (n= 222) were compared with the EQ-5D reference norms from France to estimate the impact of asthma on patients' HRQoL. Persistent asthma has a moderately negative HRQoL impact on patients of both genders, and the youngest women have been identified as a high risk group which merits further research. We identified asthma control as the major factor associated to impaired HRQoL in patients, regardless of their gender, suggesting that asthma HRQoL impact could be alleviated by achieving a good symptom control.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.

Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.
The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).

This thesis examines the burden of asthma and its determinants though a series of longitudinal observational studies. Objectives: 1) To quantify the natural history of severe asthma and the impact of early risk factors; 2) To examine the influence of socioeconomic status (SES) on excess direct medical costs of moderate-to-severe asthma and guideline-based asthma care; 3) To estimate excess costs of asthma and the economic implications of comorbidities; 4) To assess the joint influences of asthma control and comorbidity on health-related quality of life. Methods: For the first three objectives, administrative health data (for the period of 1997-2013) were obtained from British Columbia (BC) Ministry of Health, and for the last objective data were obtained from the Economic Burden of Asthma (EBA) study in BC. Various models for longitudinal data were applied for each objective. Findings: 1) Most patients (83%) with incident severe asthma transitioned to milder states after 10 years. Low SES and comorbidity at disease onset led to worse long-term prognosis. 2) Across both individual- and neighborhood-levels, there was evidence that low-SES asthma patients and/or their care providers did not follow guideline-based asthma care and subsequently incurred substantially greater excess costs of asthma. 3) Excess costs in patients with asthma were $1187/year (95%CI $1130─$1243) overall, with comorbidity-attributable costs five times higher than asthma-attributable costs, all of which greatly increased with age. 4) Changes in asthma control had a greater effect on disease-specific (AQ5D) than generic (EQ5D) utilities, whereas changes in comorbidity burden had a larger impact on EQ5D than AQ5D utilities. Conclusions: With several novel methodology techniques, this thesis provided evidence for the first-time on the long-term trajectory and burden of asthma. Projection of cost and effectiveness of decisions and policies in asthma care requires a robust understanding of the natural history of asthma, effect of risk factors on this trajectory, and estimates of costs and health-related quality of life associated with asthma. This thesis provides new evidence on all such parameters. These findings have direct relevance to estimating cost-effectiveness of health technologies in asthma and can result in more informed decision-making in health policy and clinical practice.
Pharmaceutical Sciences, Faculty of
Graduate

Summary Bronchial asthma (BA) is considered to be the disease of civilization. Life conditions of the people improve and liability to alergies becomes more intensive. Air polution determines, that asthma spreads fastly in all the world and has become a world problem of health. Asthma has exacerbated quality of life of many asthmatic people: it causes discomfort, psychological tension. Financial losses are much easier beared by a patient than social barrier, however, poor financial situation influences deeply the quality life of the asthmatic people. The goal of this work: to estimate the quality of life of asthmatic people. The following tasks have been set up in achieving this goal: 1. To evaluate the quality of life of astmatic people using SGPQ. 2. To evaluate the influence of BA to patient’s quality of life; 3. To define training impact of BA to quality of life. Investigations have been carried out using SGPQ. 100 patients - asthmatic people have been interviewed according to unanimous questionnarie for no less than one year. Totally the interview have passed 53 men and 47 women, i.e. 53 percentage of men and 47 percentage of women of totally interviewed. Age census of both gender groups was from 18 till 75 years old. Accordingly, the average age of the investigated group was 49,8. Hence, while evaluating harm character of QL, the patients pointed, that the following symptoms mostly disorganize their quality of life (defined calculated interval –... [to full text]

Many respiratory patients misuse their inhaler. Although training improves their inhaler technique, patients do forget the correct inhaler use with time. In the current work, three clinical studies investigated novel tools designed with feedback mechanisms to ensure patients use the correct inhalation method when using their inhaler. Research Ethics Committee approval was obtained and all the participants signed an informed consent form. In the first study, the recruited asthmatic children (n=17) and adults (n=39) had their metered dose inhaler (MDI) technique assessed. Those who attained the recommended inhalation flow rate (IFR) of < 90 l/min through their MDI formed the control group. Whilst those who had a poor MDI technique with an IFR ¿ 90 l/min were randomized into either the verbal counselling (VC) group; or the 2ToneTrainer (2TT) group that, in addition to the verbal training, received the 2ToneTrainer MDI technique training device equipped with an audible feedback mechanism of correct inhalation flow. All the participants were assessed on two occasions (6 weeks apart) for their inhalation flow rate, asthma control and quality of life. The study showed that the 2ToneTrainer tool was as efficient as verbal training in improving and maintaining the asthmatic patients¿ MDI technique, particularly using the recommended slow inhalation flow through the MDI. Although statistically insignificant, potential improvement in quality of life was demonstrated. The 2ToneTrainer tool has the advantage of being available to the patients all the time to use when they are in doubt of their MDI technique. In the second research study, the inhalation profiles of asthmatic children (n=58) and adults (n=63), and of COPD patients (n=63) were obtained when they inhaled through the novel Spiromax dry powder inhaler (DPI) which was connected to an electronic pressure change recorder. From these inspiratory profiles; the peak inhalation flow, inhalation volume and inhalation acceleration rate were determined. The variability (23% - 58%) found in these inhalation profile parameters among various patient groups would be expected in all DPIs. The effect of the inhalation acceleration rates and volumes on dose emission characteristics from DPIs should be investigated. Attention, though, should be paid to the patients¿ realistic inhalation profile parameters, rather than the recommended Pharmacopoeial optimal inhalation standard condition, when evaluating the in-vitro performance of DPIs. Finally, in preschool asthmatic children, the routine use of the current AeroChamber Plus spacer (n=9) was compared with that of a novel version; the AeroChamber Plus with Flow-Vu spacer (n=10) over a 12-week period. The Flow-Vu spacer has a visual feedback indicator confirming inhalation and tight mask-face seal. The study showed that the new AeroChamber Plus with Flow-Vu spacer provided the same asthma control as the AeroChamber Plus in preschool children and maintained the same asthma-related quality of life of their parents. However, the parents preferred the new Flow-Vu spacer because its visual feedback indicator of inhalation reassured them that their asthmatic children did take their inhaled medication sufficiently.

Many respiratory patients misuse their inhaler. Although training improves their inhaler technique, patients do forget the correct inhaler use with time. In the current work, three clinical studies investigated novel tools designed with feedback mechanisms to ensure patients use the correct inhalation method when using their inhaler. Research Ethics Committee approval was obtained and all the participants signed an informed consent form. In the first study, the recruited asthmatic children (n=17) and adults (n=39) had their metered dose inhaler (MDI) technique assessed. Those who attained the recommended inhalation flow rate (IFR) of < 90 l/min through their MDI formed the control group. Whilst those who had a poor MDI technique with an IFR ≥ 90 l/min were randomized into either the verbal counselling (VC) group; or the 2ToneTrainer (2TT) group that, in addition to the verbal training, received the 2ToneTrainer MDI technique training device equipped with an audible feedback mechanism of correct inhalation flow. All the participants were assessed on two occasions (6 weeks apart) for their inhalation flow rate, asthma control and quality of life. The study showed that the 2ToneTrainer tool was as efficient as verbal training in improving and maintaining the asthmatic patients' MDI technique, particularly using the recommended slow inhalation flow through the MDI. Although statistically insignificant, potential improvement in quality of life was demonstrated. The 2ToneTrainer tool has the advantage of being available to the patients all the time to use when they are in doubt of their MDI technique. In the second research study, the inhalation profiles of asthmatic children (n=58) and adults (n=63), and of COPD patients (n=63) were obtained when they inhaled through the novel Spiromax dry powder inhaler (DPI) which was connected to an electronic pressure change recorder. From these inspiratory profiles; the peak inhalation flow, inhalation volume and inhalation acceleration rate were determined. The variability (23%-58%) found in these inhalation profile parameters among various patient groups would be expected in all DPIs. The effect of the inhalation acceleration rates and volumes on dose emission characteristics from DPIs should be investigated. Attention, though, should be paid to the patients' realistic inhalation profile parameters, rather than the recommended Pharmacopoeial optimal inhalation standard condition, when evaluating the in-vitro performance of DPIs. Finally, in preschool asthmatic children, the routine use of the current AeroChamber Plus spacer (n=9) was compared with that of a novel version; the AeroChamber Plus with Flow-Vu spacer (n=10) over a 12-week period. The Flow-Vu spacer has a visual feedback indicator confirming inhalation and tight mask-face seal. The study showed that the new AeroChamber Plus with Flow-Vu spacer provided the same asthma control as the AeroChamber Plus in preschool children and maintained the same asthma-related quality of life of their parents. However, the parents preferred the new Flow-Vu spacer because its visual feedback indicator of inhalation reassured them that their asthmatic children did take their inhaled medication sufficiently.

Introdução: A asma é caracterizada por um processo inflamatório crônico que está associado ao desenvolvimento da hiperresponsividade brônquica (HRB). O exercício físico regular proporciona inúmeros benefícios aos pacientes com asma porém, os efeitos do treinamento físico na HRB permanecem pouco compreendidos. Objetivo: Avaliar o efeito do treinamento físico aeróbio na hiperresponsividade brônquica, inflamação pulmonar, controle clínico e fatores relacionados à qualidade de vida de pacientes adultos com asma persistente moderada a grave. Métodos: Cinquenta e oito adultos com asma moderada a grave foram divididos aleatoriamente, em dois grupos: Controle (GC, n=28) e Treinado (GT, n=30). Os pacientes do GC foram submetidos a um programa educacional e a um programa de exercícios respiratórios, enquanto os pacientes do GT foram submetidos a todos os procedimentos do GC e a um programa de condicionamento físico aeróbio. A hiperresponsividade brônquica foi avaliada através do teste de broncoprovocação inespecífica com histamina antes e após a intervenção. Nestas ocasiões, todos os pacientes também realizaram, análise do escarro induzido e da fração exalada de óxido nítrico, espirometria, teste ergoespirométrico e responderam aos questionários de controle clínico, fatores de saúde relacionados à qualidade de vida (FSRQV) e níveis de depressão. Além disso, foi coletada uma amostra do sangue venoso dos pacientes para quantificação do IgE total e de IgE específica. Resultados: Após três meses de intervenção, os pacientes do GT aumentaram 1 dupla dose de concentração (dd) (1 dd; 0,3-1,7 dd, 95% CI) (p < 0,05) enquanto o GC (0,06 dd; -0,6dd a 0,7 dd, 95% CI) não apresentou mudança significativa na hiperresponsividade brônquica. A inflamação pulmonar reduziu apenas nos pacientes do GT que apresentaram níveis elevados de eosinófilos (> 3%) e FeNO (> 26ppb) (p < 0,05). O condicionamento aeróbio melhorou os FSRQV, controle clínico da asma e níveis de depressão (p < 0,05). Conclusão: Nossos resultados demonstram que o treinamento aeróbio tem um efeito anti-inflamatório importante na asma e deve ser considerado como um tratamento complementar para o manejo da doença
Introduction: Asthma is characterized by a chronic inflammatory process that is associated with the development of bronchial hyperresponsiveness (BHR). Regular exercise provides numerous benefits in patients with asthma; however, the effects of exercise training on BHR remain poorly understood. Objective: To evaluate the effect an aerobic training on bronchial hyperresponsiveness, pulmonary inflammation, clinical control and health related quality of life (HRQoL) in adults patients with moderate to severe asthma. Methods: Fifty-eigth patients adults with moderate to severe asthma were randomly assigned into two groups: Control (CG, n = 28) and Trained (TG, n = 30).The GC patients undertake an educational program and performed breathing exercises, while the TG patients underwent the same procedures than CG plus an aerobic training program. Bronchial hyperresponsiveness was assessed by nonspecific bronchial provocation test with histamine before and after the intervention. On these occasions, all patients also performed induced sputum analysis and fractional exhaled nitric oxide (FeNO), spirometry, cardiopulmonary exercise testing and fulfilled questionnaires to evaluate clinical control test, HRQoL and depression levels. In addition, blood samples were collect in order to quantify total serum immunoglobulin (IgE) and specific IgE. Results: After 3 months of intervention, the TG increased 1 double dose of concentration (dd) (0.3 to 1.7 dd, 95% IC) and CG did not change significantly on bronchial hyperresponsiveness 0.06 dd (-0.6 to 0.7 dd, 95% IC) (p < 0.05).The pulmonary inflammation reduced only in the GT patients with high levels of eosinophils (> 3%) and FeNO (> 26ppb) (p < 0.05). Aerobic training also improved HRQoL, clinical control and depression levels (p < 0.05).Conclusion: Our results demonstrate that aerobic training exercise has a significant anti-inflammatory effect on asthma and should be considered as a complementary treatment for disease management

Face à l'asthme pédiatrique, il est important de cerner ce qui influence la qualité de vie et l'adhérence thérapeutique. Afin de répondre à cette question, quatre axes d'analyses ont été développés à travers l'évaluation des caractéristiques de l'enfant (le sentiment d'auto efficacité, les attitudes face à la maladie, les représentations de l'asthme) et de ses parents (le sentiment d'efficacité dans la gestion de la maladie de leur enfant, les représentations de l'asthme et leur implication dans le traitement). Puis, à partir de ces quatre axes, deux propositions de modélisations de l'influence de ces variables sur la qualité de vie et l'adhérence thérapeutiques des enfants ont été réalisées. Cette recherche a été menée auprès de 144 enfants asthmatiques âgés de 8 à 12 ans et de 92 parents. L'analyse des données empiriques a permis de mettre en évidence, pour la première fois, le rôle essentiel des représentations cognitives et émotionnelles de l'asthme chez les enfants, sur leur qualité de vie et leur adhérence. Accéder à ces représentations de la maladie que l'enfant asthmatique et ses parents se construisent, devrait permettre d'adapter les interventions au sein des programmes d'éducation des Ecoles de l'asthme avec comme objectifs une amélioration de la qualité de vie et une meilleure adhérence thérapeutique de l'enfant
The purpose of this study was to investigate what influence quality of life and therapeutic adherence in pediatric asthma. In order to answer to this question, four point of view analysis were developed through the evaluation of children's characteristics (self-efficacy, attitude, asthma representations) and their parents (self efficacy in the management of illness, asthma representations and involvement in treatment). Then, from these four point of view analysis, two explanatory models of the quality of life and the adherence among children suffering asthma were realised. The population of this research was constituted by 144 asthmatic children 8 to 12 years old and 92 parents. The analysis of empirical data showed up for the first time the essential part of asthma cognitive and emotional representations on quality of life and therapeutic adherence among children. Having access to children's and parent's illness representations, should lead to the adaptation of asthma self-management programs in order to improve children's quality of life and therapeutic adherence

Introduction: Quality of life in elderly asthmatics seems to be lower, on the one hand, than that in younger asthmatics, due to a lower degree of disease control and the presence of co-morbidities and, on the other hand, than that in elderly non asthmatics. However, there are very few studies on quality of life in elderly asthmatics. The objectives of this study were to assess quality of life of elderly asthmatics and to determine factors that might influence it. Methods: The sample included individuals aged 18 and older, elderly and non-elderly adults, with a confirmed diagnosis of Bronchial Asthma, followed up at hospital outpatient clinics, and individuals aged 18 and older, elderly and non-elderly adults without any symptoms or diagnoses of respiratory disease, followed up at Healthcare Centre outpatient clinics. After giving written informed consent, volunteers replied to some questionnaires: the Geriatric Depression Scale (GDS-15), the Center for Epidemiologic Self-Report Depression Scale (CES-D), the Mini-Mental State Examination (MMES), the Asthma Control Test (ACT), the Control of Allergic Rhinitis and Asthma Test (CARAT), the Global Initiative for Asthma (GINA), the Asthma Quality of Life Questionnaire (AQLQ), the St. George’s Respiratory Questionnaire (SGRQ), the Short Form (SF-36) Health Survey and the EQ-5D-5L Instrument. Data was analyzed using the Statistical Package for Social Sciences (SPSS), version 22.0®, and a p-value less than or equal to 0.05 was regarded as significant for all statistical tests. Results: Three hundred and ninety two volunteers, including ninety two elderly asthmatic patients, with a mean age of 72.9 years were studied. Most elderly patients were female, smokers, with low level of schooling and social class and retired from the textile/wool industry. Elderly patients with atopic and long standing asthma predominated, with a family history of respiratory disease, showing a low degree of asthma symptom control. Most patients had errors in their inhalational technique. General quality of life was relatively high but lower than that of elderly non-asthmatics. Asthma-specific quality of life was also relatively high, but lower than that of non-elderly asthmatic patients and it was influenced by the degree of asthma control, as well as by the presence of heart failure and diabetes mellitus, but not by rhinitis or gastroesophageal reflux disease, in contrast with non-elderly asthmatic patients. Conclusion: General and asthma-specific quality of life in elderly asthmatics is relatively high, but lower when compared with elderly non-asthmatics volunteers and non-elderly asthmatic patients, respectively. Generic and asthma-specific health-related QoL differentially capture the impact of symptom control and comorbidity in asthma. Asthma-specific quality of life in the elderly is directly related to the degree of asthma control, and it is influenced by cardiovascular and metabolic co-morbidities. There should be a higher focus on the optimization of self-education and treatment of both BA and relevant co-morbidities in these patients.
Introdução: A qualidade de vida nos idosos asmáticos parece ser inferior, por um lado, à da população asmática mais jovem, devido ao menor grau de controlo da doença e à presença de co-morbilidades, e por outro lado, aos idosos não asmáticos. Contudo, existem poucos estudos sobre Qualidade de Vida em idosos asmáticos. Assim, os objetivos deste estudo são avaliar a qualidade de vida de asmáticos idosos e determinar quais os fatores que a podem influenciar. Métodos: A amostra incluiu indivíduos com mais de 18 anos, com o diagnóstico de Asma Brônquica, seguidos em consulta hospitalar, e indivíduos com mais de 18 anos, não asmáticos, seguidos em consulta do centro de saúde. Após assinarem o consentimento informado, os voluntários responderam a questionários: Escala de Depressão Geriátrica (GDS-15), a Escala de Depressão do Centro de Epidemiologia (CES-D), o Mini-Mental State Examination (MMES), o Teste de Controlo da Asma (ACT), o Teste de Controlo da Asma e da Rinite Alérgica (CARAT), os níveis de controlo dos sintomas da asma (GINA), o Questionário de Qualidade de Vida na Asma (AQLQ), o Questionário do Hospital St. George sobre a Doença Respiratória (SGRQ), o Questionário do Estado de Saúde SF-36 e o Questionário EQ-5D-5L. Os dados foram analisados através do Pacote de Software para Ciências Sociais (SPSS), versão 22.0®, e um valor-p inferior ou igual a 0,05 foi considerado significativo em todos os testes estatísticos. Resultados: Foram avaliados 392 voluntários. Destes, 92 eram idosos asmáticos, com idade média de 72,9 anos, maioritariamente do sexo feminino, fumadores, com baixo nível de escolaridade e classe social e reformados da indústria têxtil. Predominaram idosos com asma não atópica, de início depois dos 18 anos, com história familiar de doença respiratória, com baixo grau de controlo da asma. Em geral, a qualidade de vida geral dos idosos asmáticos era de razoável a relativamente boa, mas inferior à dos idosos não asmáticos. Também a qualidade de vida relacionada com a asma brônquica era relativamente elevada, mas menor quando comparada com os não idosos asmáticos, sendo influenciada pelo grau de controlo da asma, pela presença de insuficiência cardíaca congestiva e diabetes mellitus. Conclusão: A qualidade de vida geral e específica da asma brônquica dos idosos com a doença, seguidos em consultas hospitalares, é relativamente elevada, embora seja inferior à de idosos não asmáticos e à de não idosos asmáticos. A qualidade de vida em asmáticos idosos está relacionada diretamente com o grau de controlo, e é influenciada por comorbilidades cardiovasculares e metabólicas.

碩士
長庚大學
護理學研究所
93
According to the data presented by Department Of Health, the mortality rate of asthma was 7.04-9.10 per 100,000 population during 1998-2002. Hospital stay number caused by Asthma increased by 16.03% and the related expense greatly increased by 44.43%. Previous studies pointed out that the uneven situation of self-care behaviors would affect patient’s life, family, and social function, which in turn would lead to the aggravation of asthma and increased the possibility of patient’s emergency treatment and re-admission. In the worst condition, patient’s life would be seriously threatened. In light of this, the present study intended to examine asthma patients’ self-care behaviors, quality of life and their related factors. The results can be served as a direction for the further nursing measures. This study was a descriptive and correlative design. Our research subjects were 220 moderate and severe asthma patients from Department of Thorax in a Medical Center located in northern Taiwan. The subjects were measured by face-to-face in structure questionnaires, which included demographic date, asthma patient self-care agency scale, asthma patient self-efficacy scale, basic needs satisfaction, health-deviation self-care requisites scale, social support scale, asthma patient self-care behavior scale and asthma patient quality of life scale, The results of this study were as follows: 1. By using independent t-test and one-way ANOVA, we found that patients with the following qualities presented better self-care behaviors: higher education, stable family economics, with religious belief, having no smoking history, having got asthma for 5-10 years, having received health education of asthma, having knowledge source of asthma self-care, higher self-efficacy, better social support, better knowledge and skill levels, and higher satisfaction on health-deviation self-care requisites. 2. By using independent t-test and one-way ANOVA, we also found that patients with the following qualities presented better quality of life: with religious belief, with few record of being sent to emergency department and no admission, lower degree of severity, and higher self-efficacy. 3. No smoking history, lower degree of severity, and better knowledge and skill levels were the predictors of self-care behaviors, which accounted for 45.5% of the total variances. 4. Lower degree of severity and better self-efficacy were the predictors of quality of life, which accounted for 17.3% of the total variances. The study examined self-care behaviors, quality of life, and their related factors in asthma patients, which could be served as a direction for nursing staffs to widely estimate the patients’ self-care behaviors and the related factors, and in turn provide the patients with better self-care measures. We suggested that further studies can aim at the factors and needs which affect patients’ self-care. Health education must be provided to satisfy the patients and expand the duration of their self-care behaviors, which in turn would enhance patients’ quality of life.

碩士
高雄醫學大學
護理學研究所
96
The purposes of this study were to (1) understand quality of life of adult patients with asthma patients; (2) explore the correlations between quality of life and each of the following factors: individual characteristics, disease characteristics, emotional distress, self-care behavior, and asthma control; (3) identify the important explanatory variables of quality of life in adult patients with asthma. This study adopted a cross-sectional correlation design. The subjects included, by convenience sampling, adult patients with asthma who were above 18 years of age and who were recruited from outpatient departments of five hospitals in Kaohsiung City, Kaohsiung County, and Pingtung County. A total of 209 valid questionnaires were acquired. Structured questionnaires including questions on individual characteristics and disease characteristics, hospital anxiety and depression scale, self-care behavior scale, asthma control test scale, and asthma quality of life scale were used for the study. The reliability and validity of these scales were tested by internal consistency, retest reliability, surface validity and context validity. Percentage, mean, standard deviation, independent t-test, one-way ANOVA, Pearson’s product moment correlation as well as stepwise multiple regression analysis were used for data analysis. The results showed (1) the standardized score of quality of life was 68.3, considered as medium level; (2) the higher the educational level or professional background, the better the quality of life, i.e. the quality of life of patients with bachelor’s degrees or higher was better than that of those subjects only graduated from high schools or lower, and the quality of life of semi-professionals, public officials, professionals and administrative staff at middle to senior levels was better than that of unskilled or non-skilled workers; the older the age, the worse the quality of life ; (3) the higher the emotional distress, the worse the quality of life; (4) the better the self-care behavior, the worse the quality of life; (5) the better the asthma control, the better the quality of life; (6) “asthma control” and “emotional distress” were important explanatory variables to quality of life, and they accounted for 67.5% of the total amount of variance. Results of this study could be used for future reference to clinical nursing care and education on the quality of life in adult patients with asthma.

Introduction: Quality of Life in elderly asthmatics seems to be lower than that in younger asthmatics, due to a lower degree of disease control and the presence of co-morbidities. However, there are very few studies on Quality of Life in elderly asthmatics. The objectives of this study are to assess Quality of Life of elderly asthmatics and to determine factors that may influence it. Methods: The sample included individuals aged 65 and older, with the diagnosis of Bronchial Asthma, followed up at hospital outpatient clinics. After giving written informed consent, volunteers replied to some questionnaires: the Geriatric Depression Scale (GDS-15), the Mini-Mental State Examination (MMES), the Asthma Quality of Life Questionnaire (AQLQ), the Asthma Control Test (ACT) and the Control of Allergic Rhinitis and Asthma Test (CARAT). Lung function was studied using spirometry and the presence of atopy was ascertained using skin prick tests and the in vitro allergen-specific IgE screening test (Phadiatop). Inhalational technique was evaluated by direct observation. Data was analyzed using the Statistical Package for Social Sciences (SPSS), version 21.0®, and a p-value less than or equal to 0.05 was regarded as significant for all statistical tests. Results: Eighty three volunteers, with a mean age of 73.4 years were studied. Most were female, never smokers, overweight, with low level of schooling and social class and retired from the textile/woll industry. Elderly patients with non-atopic and late onset asthma predominated, showing a low degree of asthma symptom control. Most patients had errors in their inhalational technique. In general, Quality of Life was relatively high and was influenced by the degree of asthma control, as well as by the presence of heart failure and high blood pressure. Conclusion: Quality of Life in elderly asthmatics is relatively high, it is directly related to the degree of asthma control, and it is influenced by cardiovascular co-morbidities.
Introdução: a Qualidade de Vida nos idosos asmáticos parece ser inferior à da população asmática mais jovem, devido ao menor grau de controlo da doença e à presença de comorbilidades. Contudo, existem poucos estudos sobre Qualidade de Vida em idosos asmáticos. Assim, os objetivos deste estudo são avaliar a Qualidade de Vida de asmáticos idosos e determinar quais os fatores que a podem influenciar. Métodos: a amostra incluiu indivíduos com 65 anos ou mais e diagnóstico de Asma Brônquica seguidos em consulta hospitalar. Após assinarem o consentimento informado, os voluntários reponderam a questionários: Escala de Depressão Geriátrica (GDS-15), o Mini-Mental State Examination (MMES), o Questionário de Qualidade de Vida na Asma (AQLQ), o Teste de Controlo da Asma (ACT) e o Teste de Controlo da Asma e Rinite Alérgica (CARAT). Avaliou-se funcionalmente as vias aéreas com espirometria e a presença de atopia foi determinada por testes cutâneos de alergia e/ou do teste de triagem para aeroalergénios in vitro (Phadiatop). A técnica inalatória foi avaliada por observação direta. Os dados foram analisados através do Pacote de Software para Ciências Sociais (SPSS), versão 21.0®, e um valor-p inferior ou igual a 0,05 foi considerado significativo em todos os testes estatísticos. Resultados: foram avaliados 83 voluntários, com idade média de 73,4 anos, maioritariamente do sexo feminino, não fumadores, com excesso de peso, baixo nível de escolaridade e classe social e reformados da indústria têxtil. Predominaram idosos com asma não atópica, de início tardio, com baixo grau de controlo da asma. A comorbilidade mais prevalente foi a hipertensão arterial e observou-se uma elevada percentagem de erros na técnica inalatória. Em geral, a Qualidade de Vida era relativamente elevada e influenciada pelo grau de controlo da asma, pela presença de insuficiência cardíaca congestiva e hipertensão arterial. Conclusão: a Qualidade de Vida dos idosos asmáticos é relativamente elevada, está relacionada diretamente com o grau de controlo e é influenciada por comorbilidades cardiovasculares.

Objectives: The objectives of this thesis were i) to quantify patients’ preferences for asthma treatments using a discrete choice experiment (DCE), ii) to evaluate the socioeconomic status (SES) impacts on these preferences, and iii) to assess the construct validity of three preference-based instruments (Health Utility Index Mark 3, EuroQol, and Short Form 6D). Methods: One hundred fifty-seven asthma patients between 19-49 years of age residing in metropolitan Vancouver, British Columbia participated in this cross-sectional study. The patients responded to three preference-based instruments, two disease-specific instruments (standardized version of the Asthma Quality of Life Questionnaire and Asthma Control Questionnaire (ACQ)), and a DCE. The DCE was designed to measure preferences for treatment benefit (symptom-free days (SFDs)), potential risks (oral thrush and tremor/heart palpitation), ease of use (frequency of daily administration and number of inhalers required), and cost. Information regarding the patient’s SES, pulmonary function, asthma medication use, and self-reported asthma control were also obtained. Results: Relationships between the relative preferences and all treatment attributes were generally in the hypothesized directions. Specifically, the patients were willing to pay an additional $14 per month to receive one extra SFD. Patients were willing to pay $26, $79, and $112 to avoid one, two, and three episodes of oral thrush, respectively, and were willing to forego 1.8, 5.5, 7.8 monthly SFDs to avoid one, two, and three episodes of oral thrush, respectively. Annual income and education level affected treatment preferences. Furthermore, the preference-based instruments were able to discriminate across levels of asthma control using the ACQ; however, there was a lack of discrimination between HRQL and asthma control using subjective measures, such as magnitude of short-acting β-agonist use and self-reported control status. Conclusions: The DCE results revealed that patients preferred treatments with more SFDs but they were willing to forego symptom relief to avoid greater frequencies of adverse events. The results demonstrated the construct validity of the preference-based instruments such that they were able to discriminate across the ACQ scores, providing evidence that preference-based instruments could detect minimal changes in asthma states.
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

碩士
佛光大學
文化資產與創意學系
102
Natural moxibustion therapy is a kind of traditional Chinese medical treatment that is historic and cultural connotations, at a specific time, the use of natural Chinese herbs, carried out on a particular acupoint in the treatment of certain diseases. Asthma is one of the common respiratory diseases. There are about 200 million worldwide and 35 million people suffer from asthma, estimated to increase to about 10 million people in 2025. It is visible that asthma affect people's health is very huge because that asthma and chronic lung disease is ranked in the first place of outpatient medical treatment for the classification, according to the report of Department of Health National Health Insurance health Statistics Annual in 2009. Health promotion is an international healthcare policy and cultural trends and the future direction of public health and it was first proposed by the World Health Organization. Being healthy is the most basic needs of ordinary people and important issues for the common culture. Therefore, this study focuses on natural moxibustion therapy for patients with asthma in the perspective of health promoting quality of life impact, and learns more about the cultural significance of natural moxibustion therapy. The method of this study is divided into literature review and interviews investigation, according to interviews with the subjects were divided into questionnaire and interview surveys. In the former longitudinal study with an interview on survey, sampling the grassroots Chinese medicine clinics in northern Taipei, Yilan, Miaoli meet the standard sampling of 34 patients with asthma were recruited. The questionnaire contained Taiwan version of "St. George's Respiratory Questionnaire" in order to carry out statistical analysis of variance analysis. The objects of the latter interview surveys were the perpetrators of natural moxibustion therapy. The results showed that there were significant difference in the asthma symptoms, limit daily activities, impact of the disease and overall impact factor between before the natural moxibustion therapy and three months after the natural moxibustion, while there were no significant difference in the asthma symptoms, limit daily activities, impact of the disease and overall impact factor between three months before the natural moxibustion therapy and three months after the natural moxibustion. In addition experts agree that drugs of the natural moxibustion were mostly Xin Wen channeling away of the goods, and therefore should not be implemented pregnant patients, skin damage, severe allergy medication does not apply. The natural moxibustion therapy is a method of health promotion, especially for improving the overall quality of life in patients with asthma helpful and worthy of further promotion. Taiwan is located with high temperature and humidity. The winter is a rush time for asthma break out. The natural moxibustion therapy has fewer side effects, deep trust and private use. We hope that this stuay could make this traditional Chinese medicine to better inheritance and development.

碩士
亞洲大學
健康管理研究所
97
Background－Asthma is a global health issue that affects approximately 3 billion people around the world. Without proper control, asthma-related medical utilization and expenses as well as social costs will increase. The emphasis of this study is to reduce the restriction on patients’ life style and improve their quality of life. Objective－(1)To utilize the WHOQOL-BREF to investigate and analyze the quality of life for asthma patients, and (2) to investigate and analyze the total medical utilization of asthma patients. Method－The study recruited patients diagnosed with asthma by thoracic physicians during the outpatient service using a purposive sample approach .The following approaches were performed, 1.Descriptive statistical analysis: to describe the distribution of demographic variables and dependent variables in the study, 2. Inferential statistical analysis: to discuss the differences among the demographic variables using t-test, ANOVA and Pearson product-moment correlation , 3.enter method multiple regression analysis: to predict the explanatory power of variables Result－Research results show that in the study that for patients participated and not participated in the asthma pilot program,self- perceived health condition and status of unemployment are considered the impact factors that affect their quality of life. In terms of total medical utilization, self-perceived health condition and age are considered the impact factors. Conclusion－Asthma is a chronic disease that has a profound impact on the quality of our daily lives, incurring a considerable amount of medical expenses for outpatient clinics, emergency services and hospitalization care. In the global promotion of disease management, the strategy of providing proper outpatient care to reduce emergency and hospitalization outcomes is of great importance. By enhancing the integration of disease management, we will have a better understanding on the medical utilization of asthma patients from different backgrounds as well as the impact on the quality of life. It is our hope that through this study, we will be able to provide better care for asthma patients in the near future.

Dissertação de mestrado em Gestão de Unidades de Saúde
Biological therapies come as an innovative treatment for patients with severe asthma, which have associated costs for the involved health units. The present dissertation aims to perform a systematic review and meta-analysis on biologic therapies for severe asthma and evaluate their efficacy and costeffectiveness for patients’ quality of life improvement. Considering the objective described, two systematic reviews and a meta-analysis were performed. Online databases were queried to analyse: a) the efficacy on quality of life (QoL) improvement of severe asthma treatment with biologicals in comparison to standard treatment, and b) the economic evaluations performed to determine the optimal intervention. The efficacy systematic review and meta-analysis (SRMA) were performed in accordance with PRISMA guidelines. The risk of bias and the certainty of the evidence were assessed using GRADE. The systematic review of economic evaluations (SR-EE) was performed in accordance with PICO and risk of bias assessment CHEC checklist. In total, 121 studies met the screening criteria (85 for the clinical SR, 10 for the MA and 36 for the SREE). Results suggested that, although there is still some uncertainty about their effectiveness, biologicals seem to improve patients’ QoL, but the effects appear to be dependent on the period of treatment and its discontinuation. The best-observed cost-effectiveness per QALY is for omalizumab, although mepolizumab showed the most effectiveness in reducing asthma control questionnaire score and improving asthma QoL questionnaire score. The results provide an overview about the efficacy and cost-effectiveness of biologicals. Although these findings demonstrated that a positive change in QoL can be attributed to these biological therapies, more evidence is needed to increase certainty and reduce the small sample bias in the meta-analysis.
As terapias biológicas surgem como um tratamento inovador para pacientes com asma grave, os quais apresentam custos significativos para as unidades de saúde envolvidas. A presente dissertação tem como objetivo realizar uma revisão sistemática e meta-análise sobre terapias biológicas para asma grave e avaliar sua eficácia e custo-efetividade na melhoria da qualidade de vida dos pacientes. Tendo em conta o objetivo descrito, foram realizadas duas revisões sistemáticas e uma meta-análise. A consulta de bases de dados online permitiram analisar: a) a eficácia na melhoria da qualidade de vida (QV) do tratamento da asma grave com medicamentos biológicos em comparação ao tratamento padrão, e b) as avaliações económicas realizadas para determinar a intervenção ideal. A revisão sistemática de eficácia e meta-análise (SR-MA) foi realizada de acordo com as diretrizes PRISMA. O risco de parcialidade e a certeza das evidências foram avaliados com o GRADE. A revisão sistemática das avaliações económicas (SR-EE) foi realizada de acordo com o PICO e a checklist de avaliação de risco de viés CHEC. No total, 121 estudos preencheram os critérios de triagem (85 para a revisão sistemática clínica, 10 para a MA e 36 para a SR-EE). Os resultados indicam que, embora ainda haja alguma incerteza sobre a sua eficácia, todos os produtos biológicos parecem melhorar a QV dos pacientes, mas os efeitos parecem ser dependentes do período de tratamento e da sua descontinuação. O melhor valor de custo-efetividade por QALY foi observado para o omalizumab, embora o mepolizumab tenha mostrado maior eficácia na redução da pontuação do questionário de controlo da asma e na melhoria da pontuação do questionário de QV da asma. Apesar de sugerirem que uma mudança positiva na QV pode ser atribuída às terapias biológicas, são necessárias mais evidências, para aumentar a certeza e reduzir o viés associado a pequenas amostras na meta-análise.
Dissertação de mestrado realizada com o apoio financeiro da Fundação para a Ciência e Tecnologia através do Estímulo ao Emprego Científico, Apoio Individual (CEECIND) – 3ª Edição (2020.01350.CEECIND) e do projeto nº UIDB/03182/2020