Quality of life in primary care asthma

Abstract

In primary care, asthma is usually assessed by means of the patients' history regarding symptoms and simple lung-function testing. These outcomes may, however, not be related to other estimates of asthma control such as quality of life. In the present study quality of life was studied in relation to symptoms (visual analogue scale, VAS) and lung function in adult patients with asthma in a primary-care setting. In a healthcare centre in Stockholm, 405 individuals diagnosed as having asthma were identified. Out of this number, 120 patients completed the study. Patients were categorized into four groups according to lung function and their response to a question regarding asthma symptoms on the VAS. Quality of life was evaluated with the Asthma Quality of Life Questionnaire (AQLQ) and current treatment was recorded. Quality of life differed significantly between the groups with regard to all domains and overall score; overall score was 6.0 (0.12)--(mean SEM) in group A (VAS < or = 2, normal FEV1), 5.4 (0.24) in group B (VAS < or = 2, low FEV1), 4.8 (0.25) in group C (VAS > 2, normal FEV1) and 4.6 (0.24) in group D (VAS > 2, low FEV1) (P < 0.0001). In general a gradient, with group A having the highest and group D the lowest score, was detected. Experience of symptoms (VAS > 2) was highly related to lower scores in the environmental domain (P < 0.0001). The correlation between FEV1 and quality of life was generally low whereas there was a fairly good correlation between VAS and quality of life (P < 0.0001 for all domains). Patients without steroid treatment had higher quality of life scores than patients treated with steroids. The majority of asthma patients in primary care have high quality of life scores, indicating a low prevalence of symptoms and only slight activity limitations. Evaluation of quality of life enables a more careful grading of asthma status. Furthermore, this measure provides information concerning asthma control that is not revealed by spirometry and simple questions regarding symptoms.