PURPOSE: Studies have assessed the relationship between asthma and health-related quality of life (QoL), however, none have examined the impact of asthma exacerbations on QoL.
METHODS: Patients aged ≥13 years (n=2,679) with severe or difficult-to-treat asthma from the TENOR, 3-year observational study with non-missing healthcare utilization at month 6 and month 12 and non-missing QoL data at month 12 were included. Exacerbation event hierarchy was defined in descending order of severity: hospitalization, emergency room (ER) visit, steroid burst, no exacerbation. Exacerbation was defined as the “highest” value in the hierarchy using both the month 6 and month 12 visits. Asthma-related QoL was measured using the MiniAQLQ at month 12. P-values comparing QoL scores at month 12 by exacerbation hierarchy were derived using the one-way ANOVA. Total number of exacerbations was also assessed using the sum of exacerbations from month 6 and month 12
RESULTS: Patients who were older, female, black, with higher body mass index and lower lung function, and those who were treated by pulmonologists were more likely to have increasing severity of exacerbations (each P<.001). MiniAQLQ scores in each domain decreased with increasing severity of exacerbation, indicating worse QoL: Overall Score, no exacerbation: 5.5±1.1; steroid burst: 4.9±1.3; ER visit: 4.3±1.5; hospitalization: 4.1±1.5 (P<.001); Symptom Domain, no exacerbation: 5.5±1.2; steroid burst: 4.8±1.4; ER visit: 4.3±1.6; hospitalization: 4.2±1.5 (P<.001); Activity Domain, no exacerbation: 5.8±1.2; steroid burst: 5.2±1.5; ER visit: 4.6±1.7; hospitalization: 4.4±1.8 (P<.001); Emotional Domain, no exacerbation: 5.6±1.5; steroid burst: 5.0±1.7; ER visit: 4.4±1.8; hospitalization: 4.2±1.8 (P<.001); Exposure Domain, no exacerbation: 5.0±1.5; steroid burst: 4.5±1.6; ER visit: 4.0±1.8; hospitalization: 3.9±1.7 (P<.001). Similar findings were observed for total number of exacerbations and asthma-related QoL.
CONCLUSIONS: Asthma exacerbations are strongly associated with asthma-related quality of life in patients with severe or difficult-to-treat asthma, with an inverse relationship between severity of exacerbations and quality of life.
CLINICAL IMPLICATIONS: Assessing the severity and frequency of asthma exacerbations may help clinicians identify which patients may be at risk for poor asthma-related QoL.
DISCLOSURE: Allan Luskin: Consultant fee, speaker bureau, advisory committee, etc.: A. Luskin has served as a Consultant/Advisor for: Merck, Genentech, Astra-Zeneca, TEVA Pharmaceutics, Sunovium, ISTA; and has received Research Support from: Merck, Genentech; and is a Speaker for: Astra-Zeneca, Merck, TEVA., Shareholder: A. Luskin owns Stock/Other direct financial holdings with: Merck, Pfizer, Mylan, Forest, Glaxo Smith-Klein, Amgen, Applera, Bristol-Myers Squibb, Lilly, McKesson, Medtronics, Proctor & Gamble, Walgreens, Other: A. Luskin is President, HealthyAirways, LLC; and Advisor, Strategic Pharmaceutical Advisors.
Ashley Yegin: Employee: A. Yegin is an employee of Genentech, Inc
Bradley Chipps: Consultant fee, speaker bureau, advisory committee, etc.: B.E. Chipps has consultant arrangements with Alcon, Inc., AstraZeneca Pharmaceuticals LP, Genentech, Inc., GlaxoSmithKline PLC, MedPointe Pharmaceuticals, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, sanofi-aventis U.S. LLC, Schering-Plough Corporation, and Sepracor, Inc, Grant monies (from industry related sources): B.E. Chipps receives grants/research support from Alcon, Inc., AstraZeneca Pharmaceuticals LP, Genentech, Inc., GlaxoSmithKline PLC, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, sanofi-aventis U.S. LLC, Schering-Plough Corporation, and Sepracor, Inc.
Lawrence Rasouliyan: Other: L. Rasouliyan is employed by ICON Clinical Research, a company that receives funding from Genentech, Inc
Dave Miller: Other: D.P. Miller is employed by ICON Clinical Research, a company that receives funding from Genentech, Inc
Tmirah Haselkorn: Consultant fee, speaker bureau, advisory committee, etc.: T. Haselkorn is a paid consultant to Genentech, Inc
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