Asthma-specific quality of life and subsequent asthma emergency hospital care

Abstract

Objective: To identify an optimal cut-point score on the Mini-Asthma Quality of Life Questionnaire (mini-AQLQ) to predict subsequent asthma exacerbations, and to determine the additional risk conferred by a prior history of acute episodes.

Study design: Cross-sectional survey linked to administrative records.

Methods: A total of 1006 HMO patients with active asthma completed surveys that included the mini-AQLQ and prior-year history of acute episodes. Surveys were linked to administrative data that captured asthma emergency department and hospital care (emergency hospital care) for the year after the survey. Optimal mini-AQLQ cut-point scores were determined by stepwise logistic regression analyses using subsequentyear asthma emergency hospital care as the outcome and various mini-AQLQ cut-points as the predictors. Predictive properties of the 2 risk factors (mini-AQLQ cut-points and prior acute episodes) were determined.

Results: A mini-AQLQ cut-point of 4.7 was most significantly associated with subsequent exacerbations in patients without a history of prior acute episodes. The presence of either a mini-AQLQ score <4.7 or a history of prior acute episodes provided high sensitivity (90.4%) and identified a group nearly 6 times more likely to require emergency hospital care than patients with neither risk factor. The presence of both risk factors provided high specificity (79.2%) and resulted in a risk ratio of 9.5 compared with the absence of both risk factors.

Conclusion: Asthma-specific quality of life and a history of acute episodes can be used together to identify patients with clinically meaningful higher and lower risks of subsequent acute exacerbations.