Quality of Life and Inflammatory Markers in Mild Asthma

doi:10.1378/chest.129.3.624

Chest

Volume 129, Issue 3, March 2006, Pages 624-631

https://doi.org/10.1378/chest.129.3.624 Get rights and content

Study objectives

The aim of this study was to explore the relationship between quality of life and measures of asthma, such as lung function, reversibility to bronchodilation, exhaled nitric oxide (NO), and bronchial responsiveness to direct and indirect stimulus in patients with mild asthma in a primary care setting.

Patients and measurements

Seventy-seven asthmatic patients not treated with glucocorticosteroids completed the Asthma Quality of Life Questionnaire. Spirometry was performed before and after bronchodilation, and bronchial challenges with methacholine and eucapnic dry air hyperventilation were conducted on separate days. NO in exhaled air and serum IgE were also analyzed.

Results

We found no correlation between quality of life and any of the other parameters. There was a significant covariation between exhaled NO and bronchial responsiveness to methacholine and dry air, and also between FEV₁ (percentage of predicted) and reversibility to a bronchodilator. The levels of exhaled NO were higher in the asthmatic subjects with atopy than in the nonatopic asthmatics.

Conclusions

The measures used in our study do not reflect health-related quality of life in subjects with mild asthma. We conclude that in the clinical situation, quality of life and other measures of asthma provide complementary information.

Section snippets

Subjects

All patients with previous symptoms diagnosed as asthma by a general practitioner were invited to participate in the study. However, it was not possible to assess whether the diagnosis of asthma had been based on peak expiratory flow variability, a reversibility test, bronchial challenges, or on a seasonal variability of asthma symptoms. The patients visited one of four health-care centers in downtown Stockholm, Sweden, and were included in the study after having been identified in the primary

Results

Seventy-seven patients were included in the study (Table 1). Results were based on the assumption that the symptoms of asthma (that had led to diagnosis of asthma by a physician), in combination with one positive test result (bronchial responsiveness, exhaled NO, reversibility test) were sufficient to confirm the diagnosis of asthma. All test results, including methacholine challenge, dry air challenge, levels of NO in exhaled air, and reversibility to bronchodilator drugs, were normal in 8 of

Discussion

In the present study, we found no correlation between quality of life as assessed by the AQLQ and parameters such as lung function, reversibility to a bronchodilator, bronchial hyperresponsiveness to a direct and an indirect stimulus, and exhaled NO in steroid-free subjects with mild asthma. Patients were included according to three criteria: asthma diagnosed by a physician, mild disease according to a VAS (< 30 mm), and no treatment with steroids (inhaled or oral) during the last 3 months

ACKNOWLEDGMENT

The authors wish to thank Professor Hans Åberg for valuable comments. The technical assistance of Kicki Olsson, RN is gratefully acknowledged.

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Feasibility and interpretation of FE<inf>NO</inf> measurements in asthma patients in general practice
2008, Respiratory Medicine
Citation Excerpt :
According to our data, more advanced age (above 61 years) and low actual FEV1 volume (below 1.5 L), not asthma symptoms may have some limitations towards the ability of patients to perform the standardised FENO test. The significant, although weak, positive correlations that were found between FENO levels and FEV1 results may be due to the wider spectrum of patient severity in the current study in comparison with mild asthmatics only, when no correlations were found between FENO and total asthma symptoms8 or quality of life.13 More interestingly, multiple stepwise forward regression analysis on mean FENO revealed that FEV1 (% pred.)
Exhaled NO (FE_NO) is a useful biomarker for the monitoring of asthma control and response to therapy. However, there is a lack of data on FE_NO levels and their interpretation in Primary Care asthma population depending on their treatment and smoking habit. Besides, the majority of current FE_NO tests have been done by stationary chemiluminescence analysers whose use is limited to research laboratories.
FE_NO measurements by the novel hand-held NO monitoring device (NIOX MINO^®) were made in 96 asthma patients (32 males, mean age 53 ± 12) at five local General Practices during their scheduled 15–20 min visits for lung function assessment.
Success rate was 78% and the intra-subject coefficient of variation was 8.7%. Inhaled corticosteroid treatment had an overall reducing effect on the FE_NO value (30.5 [19.8–49.8]) vs. patients not on the ICS (26.5 [19–94]) (p < 0.044). FE_NO levels in the ICS treated current or ex-smokers group of patients were still significantly above the normal values (p < 0.0001).
FE_NO levels were similar in patients receiving ICS whether there were current, ex-smokers or non-smokers. The highest FE_NO levels (94 [15.8–151]) were found in asthmatic current smokers and not receiving treatment with ICS. The most “normalised” FE_NO levels (35.3 [13.5–35.3]) were seen in ex-smokers.
FE_NO measurements performed with a new hand-held monitoring device are reproducible and feasible in General Practice in the majority of patients of different ages and asthma severities. A high percentage of patients with different severities of asthma and regardless of their treatment with ICS and current smoking habit (current and/or ex-smokers) had highly elevated FE_NO values, suggesting that their current therapy was possibly insufficient to control the underlying degree of airway inflammation and asthma symptoms.
The use of fraction of exhaled nitric oxide in pulmonary practice
2008, Chest
Citation Excerpt :
Because FeNO increases quickly once medication is stopped,10 it has been used to monitor adherence to antiinflammatory medication.7576 There is no correlation between FeNO and quality of life as measured by the asthma quality of life questionnaire in steroid-naïve asthmatic patients.77 The literature prior to the 1999 ATS recommendations78 can be difficult to interpret because of the different methodologies employed in measuring the FeNO.
The measurement of the fractional concentration of exhaled nitric oxide (FeNO) is a convenient, noninvasive, point-of-service office test for airway inflammation. The first half of this practice management review presents the methodological, interpretative, and clinical applications of FeNO. The second half discusses practical management issues, including current and future technology, equipment specifications, US Food and Drug Administration regulations, cost, current procedural terminology coding, and reimbursement. The measurement of FeNO is helpful in the diagnosis of asthma. It is predictive of a response to inhaled corticosteroids (ICSs). Monitoring FeNO is useful in maintaining asthma control by allowing the assessment of adherence to medication and dose titration of ICSs. An elevated level of FeNO is predictive of asthma relapse following corticosteroid withdrawal especially in children. The advances in technology, ease of use, and clinical utility will lead to greater availability, acceptance, and routine application in the care of asthma.
Perceived triggers of asthma: Evaluation of a German version of the Asthma Trigger Inventory
2008, Respiratory Medicine
Citation Excerpt :
Convergent information from additional tests such as allergen provocation or total serum IgE could improve the association between patients’ perception and actual somatic responses. However, low associations are also typically found for other aspects of self-report and somatic markers in asthma, such as symptom report and lung function measurements,18,19 perceived airway obstruction and levels of experimentally induced obstruction,20 report of asthma-specific quality of life and airway inflammation,21 or more generally between variables of the self-report domain and physiological data.22 In practice, it is important to take into account such weak associations between self-report and somatic response.
Patients’ perception of asthma triggers has been explored in a largely unstructured fashion in the past. Therefore, we developed the Asthma Trigger Inventory (ATI), a questionnaire that allows for a psychometrically valid measurement of patients’ perceived asthma triggers. Here we evaluate a German language version of the ATI and studied the relationship of subscales with self-reported health status, health care use, psychopathology, and results of allergy skin testing.
Data were obtained from 370 asthma patients recruited from the community, primary care, and in-patient asthma treatment and education.
Analysis revealed a five-factor structure that largely confirmed results with the English original. Reliability was good to satisfactory (Cronbach's α=0.77–0.89) for allergy, exercise, air pollution/irritants, infection, and psychological trigger subscales. In hierarchical regression analysis adjusting for demographics and asthma severity, asthma patients with stronger non-allergic triggers showed less physical and mental well-being and more asthma-related health care use. Psychological triggers showed unique associations with anxious and depressed mood. Pollen and animal allergen scores of the ATI were significantly related to skin test results for relevant allergens. Non-allergic but not allergic triggers showed substantial associations with asthma control.
The German version of the ATI reliably measures asthma patients’ trigger perceptions. Non-specific asthma triggers exert a greater burden on patients’ well-being and primary health care use.
Allergic diseases and their impact on quality of life
2006, Annals of Allergy, Asthma and Immunology
To review the results of studies that have evaluated the impact of allergic diseases on patients' health-related quality of life (HRQL).
We performed a MEDLINE search of the literature published between January 1990 and May 2006 (English language only) on HRQL and allergic diseases.
Representative studies that used validated questionnaires that assessed the effect of allergic diseases on HRQL were selected for inclusion in this review.
Allergic diseases can deeply interfere with patients' HRQL, with detrimental effects on the physical, psychological, and social dimensions of life. Numerous validated questionnaires that are now available can easily be adopted; most of them are specifically developed for rhinitis and asthma.
HRQL has become an increasingly important aspect in outcome evaluation in health care research, providing a more comprehensive approach to the patient and proving that nowadays we cannot renounce this tool. Most of the studies evaluate patients with respiratory allergy. Further studies are needed to explore HRQL in other allergic conditions (urticaria, food allergy, sting allergy, drug allergy) by means of specific, validated questionnaires.
Predictors of change in asthma-related quality of life: a longitudinal real-life study in adult asthmatics
2023, Quality of Life Research
Predictors of asthma-related quality of life in a large cohort of asthmatics: A cross-sectional study in a secondary care center
2021, Clinical and Translational Allergy

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This study was supported by the Centre for Allergy Research at Karolinska Institutet, the Swedish Heart-Lung Foundation, and the Swedish Asthma and Allergy Association.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

View full text

Chest

Original Research: ASTHMAQuality of Life and Inflammatory Markers in Mild Asthma

Study objectives

Patients and measurements

Results

Conclusions

Section snippets

Subjects

Results

Discussion

ACKNOWLEDGMENT

Respir Med

Respir Med

J Allergy Clin Immunol

J Clin Epidemiol

Chest

Chest

Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study

Eur Respir J

Measuring quality of life in asthma

Am Rev Respir Dis

Increase in exhaled nitric oxide levels in patients with difficult asthma and correlation with symptoms and disease severity despite treatment with oral and inhaled corticosteroids: Asthma and Allergy Group

Thorax

Exhaled nitric oxide–is it really a good marker of airway inflammation in bronchial asthma?

Respiration

Measurement of airway inflammation in asthma

Curr Opin Pulm Med

Asthma, chronic bronchitis and respiratory symptoms: prevalence and important determinants

Umeå University Medical Dissertations New Series No. 387

American Thoracic Society.. Standardization of spirometry, 1994 update

Am J Respir Crit Care Med

Reference values for lung function tests in females: regression equations with smoking variables

Bull Eur Physiopathol Respir

Original Research: ASTHMA
Quality of Life and Inflammatory Markers in Mild Asthma