Abstract
Background: Quality-of-Life (QoL) decrease with the degree of asthma severity, but can significantly change depending on age, gender, socioeconomic status, comorbidities (Siroux, Allergy 2008).
Aim: To evaluate the main determinants of QoL in patients with severe asthma (SA) defined according to ERS/ATS document (Chung, ERJ 2014).
Method: We studied 72 patients with SA by spirometry, methacholine test (after 24 hours of stop of inhaled therapy), airway inflammation, Asthma-Control-Test (ACT) questionnaire, (not controlled (NC) asthma if ACT<20), Asthma Quality-of-life Questionnaire (AQLQ) and Short-Form-36 (SF-36) questionnaire.
Results: We examined age, gender, smoke, FEV1, bronchial hyperresponsiveness (BH), sputum eosinophilia, obesity, chronic rhinosinusitis, gastroesophageal reflux (GER), mental disorders, exacerbations as potential determinant of QoL. AQLQ score significantly decreased with BH (4.4 vs 5.8), NC asthma (4.1 vs 5.7), obesity (4.4 vs 5.0) and GER (4.4 vs 5.0); SF-36 Physical Component Summary (PCS) score significantly decreased with age (32.9 vs 39.8), BH (35.5 vs 51.8), NC asthma (31.1 vs 45.7) and GER (33.4 vs 39.8); SF-36 Mental Component Summary (MCS) score significantly decreased with GER (39.6 vs 47.5) and exacerbations (42.3 vs 50.4). Stepwise logistic regression was performed, using as dependent variable a score<median value. Of all examined variables, lower AQLQ was associated with NC asthma (OR(95%CI): 8.9(1.7-47.8),p=0.01) and BH (OR(95%CI): 5.0(1-25.4),p=0.05); lower PCS score with BH (OR(95%CI): 9(1.4-58.4),p=0.02); lower MCS score with GER (OR(95%CI): 8.8(1.3-57.4),p=0.02).
Conclusions: In SA, QoL is mainly associated with asthma control and BH, with minimal influences by comorbidities.
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