ReviewAsthma severity and child quality of life in pediatric asthma: A systematic review☆
Introduction
Clinicians and researchers routinely use quality of life (QOL) as an indicator of treatment success in pediatric asthma. Measures of QOL are thought to indicate how much an individual's illness interferes with daily life and how well the patient is adapting to his or her illness across several areas of functioning such as social, emotional, and physical [1]. Thus, QOL assessments are used to measure the effectiveness of medical treatments and other interventions in improving patient functioning and adaptation to a chronic illness [2]. Healthcare providers who treat children with asthma often utilize these outcome measures in their decisions about treatment planning and medication usage. However, the relationship between disease severity and child QOL in pediatric asthma is not well established. For example, symptoms of poorly controlled asthma such as wheezing and night-time waking, thought to disrupt daily and nightly activities, are not consistently associated with measurements of child QOL in some studies [3], [4], whereas other studies report such relationships [5], [6]. Thus, the overall aim of this review was to evaluate the degree to which asthma severity is a correlate of child QOL across several studies.
In pediatric asthma, the lack of a consistent relationship between asthma severity and child QOL may be due to inconsistencies in the way in which asthma severity is measured (e.g., symptoms, limited activities, night waking and pulmonary function tests). As QOL is conceptualized as being comprised of patient functioning across several domains (e.g., physical, psychological and social), factors related to asthma severity should influence child QOL [7]. Yet, the inconsistent relationship between severity and QOL suggests that factors independent of physical indicators may instead influence child QOL [8]. It might also be that the relationship between severity and child QOL holds only under certain conditions or depending upon how severity is measured. For instance, asthma severity is often classified based on patient and/or caregiver retrospective recall of symptoms or according to physician judgment following published guidelines for asthma care [9].
There is little agreement among researchers as to which methods to use to classify asthma severity [10]. For instance, a researcher may utilize the guidelines from National Heart, Lung and Blood Institute (NHLBI) or guidelines from the National Asthma Education and Prevention Program (NAEPP) in determining severity. Guidelines from the NHLBI rely on several variables for classifying asthma severity: medication usage, lung function, symptoms, symptom interference with normal activities, and night-time waking [11]. The NAEPP, which is an initiative of the NHLBI, utilizes three techniques for classifying severity: frequency of asthma symptoms during the day, frequency of nighttime asthma symptoms, and measures of pulmonary function [11]. Still other researchers might rely on other national guidelines depending on the location of their study (e.g., the British Guidelines on the Management of Asthma). Ortega et al. [12] speculate that there is such a variety of ways to classify asthma severity, in part, because health professionals are unsure of which factors should be utilized to evaluate asthma severity. Thus, in assessing the relationship between asthma severity and child QOL, this review considered how classification of asthma severity might influence this relationship.
Based on previous reviews evaluating the psychometric properties of QOL measures in pediatric populations [13], [14], [15], [16], [17], [18], this review also considered type of QOL measure (e.g., generic vs. disease-specific) and informant (e.g., parent vs. child) in the relationships between asthma severity and child QOL. For instance, generic QOL measures are used to measure multiple domains of functioning related to QOL and can be used with healthy and ill populations [15]. Disease-specific measures report on a person's QOL as it relates specifically to a certain medical condition. Generic measures, therefore, allow for comparisons across diseases and between healthy and ill individuals. Disease-specific measures do not have such flexibility, but are considered more sensitive to clinical changes [15]. With respect to informant choice, it is often suggested that based on the cognitive and emotional development of children, young children are not able to accurately report on their current level of QOL [7], [14]. To combat such issues related to child report, certain QOL measures are designed for completion by the child's parents. However, this methodology is also cause for concern in that parent report of child QOL is likely to be influenced by parental biases and expectations [14]. Parent report can also obscure the accuracy of a child's symptoms or functioning if the parent is emotionally distressed [3]. In fact, the results of a parent-completed child QOL measure may be quite different from the child's actual experience with his or her illness.
Therefore, in assessing asthma severity as a correlate of child QOL, our review had three goals. First, we aimed to examine whether classification of asthma severity influenced the relationship between asthma severity and child QOL. We identified three ways that asthma severity was classified in our studies: (1) from parent or child report of asthma symptoms, (2) published guidelines and (3) medication usage criteria from published guidelines. Second, we sought to determine whether the type of QOL instrument utilized (e.g., generic vs. disease-specific) influenced the strength of this relationship. Finally, we considered whether informant of child QOL (e.g., child vs. parent) altered the strength of the relationship between asthma severity and child QOL in pediatric asthma.
Section snippets
Study selection
Online bibliographic databases (PsycINFO, PsycARTICLES, and MEDLINE) were searched using numerous combinations of the following keywords: child, children, adolescent, pediatric, chronic illness, quality of life, QOL, asthma and severity. As QOL literature in pediatric asthma is relatively recent and has been at the forefront of QOL research since the introduction of Juniper et al.’s [19] popular measure, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), little research prior to 1996
Asthma severity and child QOL
Across the fourteen studies [3], [4], [8], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], children ranged in age from 2 to 18 years and exhibited mild to severe asthma. As nine of these studies [8], [21], [22], [24], [25], [26], [28], [29], [30] found a significant association between asthma severity and child QOL, there is evidence to support asthma severity as a correlate of child QOL in pediatric asthma. Twelve studies [3], [4], [8], [20], [21], [22], [24], [25], [26], [28]
Discussion
Current evidence from this review of 14 studies found strong support for asthma severity as a significant correlate of child QOL in pediatric asthma. Overall, the reviewed studies found that as the severity of the child's asthma worsened, the QOL of the child declined. This is consistent with the inverse relationship between severity and QOL found in a review considering the relationship between asthma severity and QOL among adults with asthma [31]. As QOL is thought of as a measure of patient
Conflicts of interest
We have no conflicts of interest to declare.
References (38)
- et al.
Psychopathology and quality of life for adolescents with asthma and their parents
Psychosomatics
(2003) - et al.
Emotional quality-of-life and outcomes in adolescents with asthma
J Pediatr
(2004) Assessment of health status and quality of life outcomes for children with asthma
J Allergy Clin Immunol
(2001)- et al.
A childhood asthma severity scale: symptoms, medications, and health care visits
Ann Allergy Asthma Immunol
(2001) Validating measures of pediatric health status, functional status, and health-related quality of life: key methodological challenges and strategies
Ambul Pediatr
(2004)- et al.
Predicting children's quality of life in an asthma clinical trial: what do children's reports tell us?
J Pediatr
(2001) - et al.
Validity and responsiveness of a brief, asthma-specific quality-of-life instrument in children with acute asthma
Ann Allergy Asthma Immunol
(2004) - et al.
Emergency department visits by urban African American children with asthma
J Allergy Clin Immunol
(2000) - et al.
Critical issues and needs in health-related quality of life assessment in children and adolescents with chronic health conditions
- et al.
Assessing children's well-being: a handbook of measures
(2004)
Influence of sociodemographics on the health-related quality of life of pediatric patients with asthma and their caregivers
J Asthma
Children and adult perceptions of childhood asthma
Pediatrics
The relationship between asthma severity, family functioning, and the health-related quality of life of children with asthma
Qual Life Res
Classifying asthma severity in children: mismatch between symptoms, medication use, and lung function
Am J Respir Crit Care Med
Variation in the distribution of patient-reported outcomes based on different definitions of defining asthma severity
Curr Med Res Opin
Expert panel report 3: guidelines for the diagnosis and management of asthma
The measurement of health-related quality of life (QOL) in paediatric clinical trials: a systematic review
Health Qual Life Outcomes
Pediatric health-related quality of life questionnaires in clinical trials
Curr Opin Allergy Clin Immunol
A review of measures of quality of life for children with chronic illness
Arch Dis Child
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Preparation of this manuscript was supported, in part, by a grant from the National Institute of Mental Health (R01 MH51771) to the second author.