THE RELATIONSHIP BETWEEN ASTHMA SYMPTOMS, QUALITY OF LIFE, AND HOSPITAL ADMISSIONS IN MODERATE TO SEVERE ASTHMA.

Background: A variety of assessment tools has been developed to quantify well-being related to a specific disease (the St. George?s Respiratory Questionnaire, SGRQ), quality of life, QOL (the Medical Outcomes Study 36-Item Short Form Health Survey, SF-36), and perceived dyspnea (the Borg scale). By examining scores obtained with these instruments, it may be possible to detect a correlation between perception of well-being and numbers of inpatient hospital days (IPH) and emergency department visits (ED).

Objective: To examine the relationship between asthma symptoms, quality of life, and hospital admissions in moderate to severe asthma.

Methods: SGRQ, SF-36, and Borg scores were obtained from subjects with moderate to severe asthma upon enrollment in an asthma disease management study (n=140). Scores were correlated with numbers of ED visits and IPH days during the 12 months prior to enrollment in the study. The SGRQ and SF-36 instruments are widely used and have been subjected to validity and reliability testing. The present form of the Borg scale (a 12-point scale used by patients to rate their perceived level of dyspnea from ?nothing at all? to ?maximal?) has been in use clinically since 1982. The SGRQ employs 3 domains: Symptoms (SGS), covering severity and frequency; Activities (SGA), covering activities that cause or are limited by dyspnea; and Impacts (SGI), covering social function and psychological disturbance resulting from airways disease. The 3 domains are compiled to yield a total score (SGT). Higher scores indicate diminished feelings of well-being. The SF-36 covers 8 domains, including physical functioning (PF), social functioning (SF), role limitations due to physical (RP) and emotional problems (RE), mental health (MH), energy and vitality (VIT), pain (P), and general health (GH). Higher scores reflect better quality of life. Results were determined by Pearson product-moment correlation with P < 0.05 being significant.

Results: An increase in ED visits correlated with an increase in SGS, SGI, and SGT scores (r=0.27 for each), indicating a decline in general well-being. An increase in IPH days also resulted in increased SGI (r=0.18) and SGT (r=0.20) scores. Decreased ED visits and IPH days were associated with increased GH scores (r=0.24), indicating higher QOL, and IPH days exhibited the same negative correlation with PF and RE scores (r=0.20 and 0.23, respectively). Interestingly, numbers of ED visits and IPH days were not related to SGA, P, VIT, SF, MH, and Borg scores. Borg scores exhibited a significant correlation with SGS, SGA, SGI, SGT, PF, RP, P, SF, RE, and MH, as expected, but did not have any relationship to numbers of IPH days or ED visits.

Conclusions: There appears to be some relationship between the frequency of admissions and patients? perceptions of symptom severity and frequency, as well as the impact of their disease on social function and psychological factors. Not surprisingly, better perceptions of quality of life in the areas of physical function, general health, and role limitations due to emotional problems were reflected in fewer admissions. However, there was no relationship between admissions and activities that cause or are limited by dyspnea. Regardless of role limitation due to physical problems, pain, vitality level, mental health, or Borg scores, there was no change in the number of admissions. The results support the fact that limitations and the impact of asthma on activities of daily living does not always result in patients? seeking medical care. This finding may be a factor in the greater risk for asthma death that is seen in this patient population.