Bronchial Asthma is inflammatory disorder of lower airway.  Chronic inflammation is caused by the hyper-responsiveness and narrowing of airways occurring as a result of different external stimuli, such as exercise and allergens. They cause wheeze, shortness of breath, coughing and chest tightness. The airflow obstruction is usually spontaneously reversible with appropriate medication [1].

Asthma was recognized in Ancient Egypt it was treated by drinking a mixture known as kyphi. It was named officially as respiratory disease in 450 BC by Hippocrates circa.  In 200 BC it was believed that asthma is related to the emotions [2].Asthma has increased significantly since 1970s. By 2009 it has been diagnosed in 300 million people worldwide and globally caused approximately 250,000 deaths [3].

Asthma is clinical syndrome leading to obstruction of airways that is partially or completely reversible. Airway hyper-responsiveness can occur from pollens, pet dander, dust mites, Irritants in the air, such as smoke, chemical fumes and strong odors. Colds, the flu or weather conditions, such as cold air or extremely dry, wet or windy weather causes asthma exacerbation. There are recurrent episodes of wheezing, breathlessness, coughing and chest tightness especially at night or in the early morning due to hyper responsiveness. These episodes lessens either spontaneously or with treatment [4].

The National Asthma Education and Prevention Program guidelines define asthma severity treatment by lung function test and symptoms (HRQL) [5]. Although asthma is more common in children than in adults. About 11 % of all asthmatics have age above 65 [6].

The lungs play central role against harmful substances present in air that pass through nose and becomes trapped in the lungs. The ciliary movement moves mucus by coughing or swallowing. In some chronic asthmatics airflow limitation is reversible partially because of airway remodeling (hypertrophy, hyperplasia of smooth muscle, angiogenesis, and sub epithelial fibrosis) that happens in chronic untreated disease [7].

Airway hyper responsiveness or bronchial hyper reactivity is an exaggerated response to many exogenous or endogenous stimuli. It includes direct stimulation and indirect stimulation of airway smooth muscle. The airway hyper responsiveness is related to severity of asthma. Exercise testing is standard method for assessing patients with exercise-induced bronchospasm [8].

Study Design

It was Cross sectional study.

Settings

Data was collected from Gulab Devi chest hospital Lahore

Target Patients

Patients were selected with moderate to severe Asthma 

Sample Size

We included total 115 patients with asthma symptoms.

Inclusion Criteria

• Chronic and Acute Cases

• Patients with age 16- 80 of either gender 

Exclusion Criteria

Patients of Asthma with other systemic disease like COPD patients.

Methodology

To determine the asthma exacerbation on quality of data was collected from patients presented at Gulab Devi Hospital. The data collected consists of 115 patients both females and males of all age groups with different socioeconomic status. Standard Mini Asthma Quality of Life Questionnaire was used to collect data with close ended questions. The data was collected within the duration of five months of all the registered and new cases. The data was collected with permission of concerned department and after approval of ethical committe on specially designed Performa. The data collected consist of the age and gender of patient, clinical appearance Mini Asthma Quality of Life Questionnaire.

Statistical Analysis

The statistical analyses were done in statistical package for social sciences (SPSS) version 16.0. The data was presented in the form of appropriate Graph or Frequency tables. Graph determined by mean ± standard deviation and categorical data is represented by frequency %.

Mean age of patients with asthma exacerbation was 36.04±14.28 with maximum age of 80 to minimum of 16 years with 21.74% male and 78.26% females. There was 0.87 % population with high socioeconomic status, 36.52 % population with low socioeconomic status and 62.61% population with middle socioeconomic status.

Out of 115 patients, 13.04% patients had shortness of breath all the time, 21.74% most of the time, 7.83% a good bit of the time, 31.30% some of the time, 25.22% a little of the time and 0.07% hardly any of the time shown in Figure 1(a). There was 61.74% patients who were bothered or need to avoid dust in the environment all of the time, 23.48% most of the time, 2.61% a good bit of the time, 2.61% some of the time, 2.61% a little of the time and 0.87% hardly any of the time, 6.09% none of the time shown in Figure 1(b).

In Figure 1(c) Out of 115 patients, 13.91% patients were frustrated as a result of their Asthma all of the time, 21.74% most of the time, 3.48% a good bit of the time, 21.74% some of the time, 26.96% a little of the time and 4.35% hardly any of the time, 7.83% none of the time.

Figure 1: (A). Distribution of Asthma Patients with Shortness of Breath, (B). Distribution of Asthma Patients Bothered by Dust in the Environment, (C). Distribution of Frustrated Asthma Patients, (D). Distribution of Asthma Patient with Coughing

Figure 2: (A). Distribution of Asthma Patients Afraid of Medication Availability, (B). Distribution of Asthma Patients with Chest Tightness or Heaviness, (C). Distribution of Asthma Patients who Feels Bothered by Smoke in the Environment, (D). Distribution of Asthma Patients with Difficult Night’s Sleep

Table 1: Statistical Analysis of Asthmatic Patients

Figure 3: (A). Distribution of Asthma Patients with Wheezing, (B). Distribution of Asthma Patients Bothered by Weather or Air Pollution, (C). Distribution of Asthma Patients with Limitations of Strenuous Activities, (D). Distribution of Asthma Patients with Limitations of Moderate Activities

Out of 115 patients, 0.07% patients were bothered by coughing all of the time, 25.22% most of the time, 4.35% a good bit of the time, 20.87% some of the time, 33.04 % a little of the time, 6.96% hardly any of the time and 8.70% none of the time as shown in Figure 1(d).

Out of 115 patients, 4.35% patients who were afraid of not having their asthma medication available all of the time, 10.43% most of the time, 4.35% a good bit of the time, 9.57% some of the time, 16.52% a little of the time, 7.83% hardly any of the time and 46.96% none of the time and the 6.09% patients experienced feel of chest tightness or chest heaviness all of the time as shown in fig 2(b), 15.65% most of the time, 6.09% a good bit of the time, 32.17% some of the time, 25.22% a little of the time, 1.74% hardly any of the time and 13.04% none of the time shown in Figure 2 (a,b).

The 65.22% need to avoid cigarette smoke in the environment, 9.57% most of the time, 1.74% a good bit of the time, 0.87% a little of the time, 1.74% hardly any of the time and 20.87% none of the time and the 9.57% patients have difficulty ingetting a good night sleep as a result of their asthma all of the time, 10.43% most of the time, 12.17% some of the time, 15.65% a little of the time, 17.39% hardly any of the time and 34.78% none of the time shown in Figure 2 (c, d).

The 3.48% patients have wheeze in their chest all of the time, 11.30% most of the time, 6.96% a good bit of the time, 36.52% some of the time, 26.96% a little of the time, 2.61% hardly any of the time and 12.17% none of the time. Out of 115 patients, 47.83% patients were bothered by weather or air pollution all of the time, 15.65% most of the time, 3.48% a good bit of the time, 0.87% some of the time, 2.61% a little of the time, 5.22% hardly any of the time and 24.35% none of the time.

The 10.43% patients had limitations of strenuous activities such as exercising, running up stairs, limited sports, 19.13% extremely limited, 35.65% very limited, 18.26% moderate limitation, 4.35% some limitation, 3.48% a little limitation and 8.70% not at all limited and 8.70% patients having limitations of moderate activities such as walking, housework, gardening, shopping, climbing stairs extremely limited, 11.30% very limited, 20.87% moderate limitation, 17.39% some limitation, 16.52% a little limitation and 25.22% not at all limited as shown in Figure 3 (a,b,c,d).

In current study asthma has significant effect on patients life and these results were correlated with previous studies that respiratory symptoms have significant impact on quality of life among patients with mild asthma. According to results mostly patients with severe Asthma have disturbed quality of life correlated with another research conducted by juniper in 2004. According to his analysis patients with severe and poorly controlled asthma have more worse quality of life than milder or  well-controlled patients [9] According to another research it was found that patients with acute asthma exacerbation have worse quality of life than that with mild or moderate asthma [10].

Asthma triggered the symptoms or exercise limitations related to the health related quality of life as in previous studies. Asthma has a considerable influence on daily living physical and social activities. Efforts are essential to improve asthma control [11]. 

According to another study asthma trigger increases severity of disease with decreased quality of health [12]. Increasing exacerbation frequency and baseline asthma triggers were associated with noteworthy decline in Mini- AQLQ domain scores. An increased number of asthma triggers were associated with an increase in severity and frequency of exacerbations. This study results also coincides with current research results, I have also found that as the asthma triggers increases, the severity of disease increases resulting decreased quality of life.           

The level of negative attitude and disease severity in asthmatics significantly impair QoL. The main objectives of health care is preserving a satisfactory quality of life in asthmatics [13]. This study also justify that worsening of asthma impairs health related quality of life. Besides clinical and functional measures, the evaluation process of the overall health status must incorporate quality-of-life measures. These studies strengthen objective of current study.

It is concluded that asthma causes a decline in health related quality of life. More the severity of asthma, the more will be the decline in health related quality of life. As the asthma trigger increases, the severity of asthma increases and ultimately there will be more decline in health related quality of life. It is concluded that with mild asthma there is less decline in health related quality of life as compared to moderate to severe asthma. So health practioners should pay a serious attention in patients having moderate to severe asthma.

1. Kerstjens, H.A. et al. “Tiotropium improves lung function in patients with severe uncontrolled asthma: a randomized controlled trial.” Journal of Allergy and Clinical Immunology, vol. 128, no. 2, 2011, pp. 308–314.

2. Mason, R.C. et al. Murray & Nadel's Textbook of Respiratory Medicine E-Book. Elsevier Health Sciences, 2015.

3. Bateman, E.D. et al. “Global strategy for asthma management and prevention: GINA executive summary.” European Respiratory Journal, vol. 31, no. 1, 2008, pp. 143–178.

4. Rai, S. et al. “Best treatment guidelines for bronchial asthma.” Medical Journal Armed Forces India, vol. 63, no. 3, 2007, pp. 264–268.

5. Moy, M.L. et al. “Clinical predictors of health-related quality of life depend on asthma severity.” American Journal of Respiratory and Critical Care Medicine, vol. 163, no. 4, 2001, pp. 924–929.

6. Ober, C., and D.L. Nicolae. “Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations.” Nature Genetics, vol. 43, no. 9, 2011, pp. 887–892.

7. Gauvreau, G.M. et al. “Effects of interleukin-13 blockade on allergen-induced airway responses in mild atopic asthma.” American Journal of Respiratory and Critical Care Medicine, vol. 183, no. 8, 2011, pp. 1007–1014.

8. Cloutier, M.M. et al. “Asthma outcomes: composite scores of asthma control.” Journal of Allergy and Clinical Immunology, vol. 129, no. 3, 2012, pp. S24–S33.

9. Juniper, E. et al. “Relationship between quality of life and clinical status in asthma: a factor analysis.” European Respiratory Journal, vol. 23, no. 2, 2004, pp. 287–291.

10. Lloyd, A. et al. “The impact of asthma exacerbations on health-related quality of life in moderate to severe asthma patients in the UK.” Primary Care Respiratory Journal, vol. 16, no. 1, 2007, pp. 22–27.

11. Wildhaber, J. et al. “Global impact of asthma on children and adolescents' daily lives: the room to breathe survey.” Pediatric Pulmonology, vol. 47, no. 4, 2012, pp. 346–357.

12. de Souza, P.G. et al. “Quality of life in children with asthma in Rio de Janeiro, Brazil.” The Indian Journal of Pediatrics, vol. 80, no. 7, 2013, pp. 544–548.

13. Ekici, A. et al. “Negative mood and quality of life in patients with asthma.” Quality of Life Research, vol. 15, no. 1, 2006, pp. 49–56.