Introduction
Asthma can impair parents and primary caregivers of children with asthma normal daily activities. Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) by Juniper et al. [
1] refers to these impairments. We have previously validated Pediatric Asthma Quality of Life Questionnaire (PAQLQ) among asthmatic children in Poland [
2]. For the purpose of the present study, we assessed correlation between asthma quality of life in parents and asthma quality of life in children as well as clinical parameters of asthma in children. We determined whether changes in caregiver’s QOL scores reflect changes in child’s QOL and their asthma severity such as clinical asthma control and physical indicators of inflammation: FENO and ΔFEV1. We tried to answer what change in the caregiver’s QOL score can be considered important.
Results
One hundred and one children and 101 caregivers completed the study; 9 patients and 9 caregivers withdrawn the consent before week #1.
We found a significant statistical correlation between asthma diary score in children and asthma quality of life in parents (from
r = −0.46 to
r = −0.53) (Table
1). These findings were consistent in both domains: activities and emotional. We did not observe any significant correlation between other clinical parameters and asthma quality of life in parents. We found significant positive correlation between PAQLQ and PACQLQ in all domains (Table
1).
Table 1
Correlation between PACQLQ score and clinical parameters and PAQLQ in children at visit 2–4
Visit 2 |
Asthma diary | −0.45** | −0.49** | −0.49** |
FeNO | 0.57 | 0.60 | 0.62 |
FEV1% changea
| 0.03 | −0.01 | −0.01 |
FEV1 | −0.01 | 0.02 | 0.03 |
PEF | 0.15 | 0.01 | 0.06 |
PAQLQ symptoms | 0.57** | 0.60** | 0.62** |
PAQLQ activities | 0.48** | 0.50** | 0.51** |
PAQLQ emotions | 0.44** | 0.40** | 0.43** |
Visit 3 |
Asthma diary | −0.45** | −0.45** | −0.46** |
FeNO | 0.52 | 0.51 | 0.52 |
FEV1% changea
| −0.02 | −0.01 | −0.02 |
FEV1 | −0.02 | 0.06 | 0.04 |
PEF | 0.19 | 0.08 | 0.11 |
PAQLQ symptoms | 0.52** | 0.51** | 0.52** |
PAQLQ activities | 0.46** | 0.48** | 0.49** |
PAQLQ emotions | 0.46** | 0.45** | 0.47** |
Visit 4 |
Asthma diary | −0.49** | −0.53** | −0.53** |
FeNO | 0.56 | 0.59 | 0.59 |
FEV1% changea
| 0.02 | −0.01 | −0.01 |
FEV1 | −0.04 | −0.08 | −0.06 |
PEF | 0.15 | 0.14 | 0.14 |
PAQLQ symptoms | 0.56** | 0.59** | 0.59** |
PAQLQ activities | 0.40** | 0.45** | 0.45** |
PAQLQ emotions | 0.46** | 0.50** | 0.50** |
We also analyzed prospectively changes in PACQLQ in relation to all clinical parameters as well as PAQLQ (Table
2). We found negative correlation between changes in PACQLQ and asthma diary in children; improvement in caregivers quality of life correlates with better asthma control in children. Changes in PACQLQ correlated positively with changes in PAQLQ.
Table 2
Correlation between changes in PACQLQ and changes in clinical parameters and PAQLQ in children
Asthma diary | −0.34** | −0.32** | −0.34** |
FeNO | 0.37 | 0.36 | 0.38 |
FEV1% changea
| −0.08 | −0.13 | −0.15 |
FEV1 | −0.03 | −0.03 | −0.02 |
PEF | 0.28 | 0.13 | 0.18 |
PAQLQ symptoms | 0.37** | 0.36** | 0.38** |
PAQLQ activities | 0.24* | 0.41** | 0.39** |
PAQLQ emotions | 0.23* | 0.29** | 0.27** |
We analyzed changes in PACQLQ score in relation to asthma control in children. We also analyzed changes in PACQLQ score separately for caregivers whose children had stable or lost/obtained asthma control between visits. We observed significant change in PACQLQ of caregivers whose children obtained asthma control, but there was no significant change when children lost asthma control (Table
3).
Table 3
Changes in PACQLQ in comparison with the changes in the level of asthma control
PACQLQa activities | 0 (−3 to 1) | 2 (0 to 4.5)** |
PACQLQ emotions | 0 (−7 to 12) | 6 (0.5 to 11)** |
Total PACQLQ score | 1 (−10 to 14) | 8 (0.5 to 16)** |
Discussion
The results of this study suggest that the PACQLQ performs well in clinical practice. The questionnaire detects differences in quality of life in caregivers with different degrees of quality of life and asthma symptoms in children. We found significant positive correlation between PAQLQ and PACQLQ in all domains. What is interesting is the correlation between changes in asthma symptoms in children is greater with PACQLQ than with PAQLQ (
r = −0.34 vs.
r = −0.22), which suggest that measuring quality of life in parents could be a useful tool in monitoring asthma in children [
2]. What is more important is measuring quality of life in caregivers, which may reflect current asthma control in children. The important finding of our study is that PACQLQ reflects better obtained asthma control in children than lost control. It seems obvious that more impaired quality of life in parents as a result of their child’s asthma affects all aspects of family life and increase a total cost of asthma management.
It is interesting that our study showed a significant statistical correlation between asthma diary score in children and asthma quality of life in parents. However, Merikallio et al. [
6] demonstrated in their study that a short-time QOL can be obtained from children, but for longitudinal observation parents’ information seems to be more adequate. In opposite to the study of Farnik et al. [
7], we found significant positive correlation between PAQLQ and PACQLQ in all domains. We did not observe any significant correlation between clinical parameters in children and asthma quality of life in parents, which stay in accordance with previous studies [
7]. We interpret these results as clinical parameters such as FEV1 and FeNO being weak indicators of disease severity especially in short-time observation of mild asthma. However, other studies have shown the correlation between children’s lung function and parental QOL questionnaire [
7]. The most impaired parent domain-emotions significantly correlated with FEV1%FVC. Even if the correlations between clinical parameters and PACQLQ are weak or none, it should not determine a limitation of this questionnaire in the management of child’s asthma.
This study also showed that the parent’s assessment of change in quality of life was more closely related to asthma diary scores in children than child’s assessment. Although this is not a diagnostic scale, it should be assessed as complement to traditional clinical evaluation.
We found significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control, but there was no significant change when children lost asthma control. In contrary to our results, Farnik et al. [
7] showed that uncontrolled asthma is associated with a reduced HRQOL in pediatric caregivers.
The limitation of the study is related to lack of other aspects of parent’s characteristics, for example, parental education or financial situation. However, in the study of Farnik et al. [
8], occupational domain in QOL in Child’s Chronic Disease Questionnaire of parents did not show any significant differences of stable and unstable children with chronic disease.
The implementation of the PACQLQ was successful in our study and would be helpful in involving parents in therapy of their children with asthma.
Acknowledgments
This study was funded by grant 502-12-760 and 503-2056-1 from the Medical University of Lodz, Poland.