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ORIGINAL ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 442-446

Quality of life among asthmatic children attending the Outpatient Clinic in Menoufia University Hospital


1 Department of Public Health, Community Medicine, Menoufia University, Shibin El-Kom, Egypt
2 Department of Chest Diseases, Faculty of Medicine, Menoufia University, Shibin El-Kom, Egypt
3 Department of Pediatric, Faculty of Medicine, Menoufia University, Shibin El-Kom, Egypt
4 Department of Family Medicine, Damat Hospital Quotor Health Administration, Tanta, Egypt

Date of Submission31-Aug-2014
Date of Acceptance19-Oct-2014
Date of Web Publication31-Aug-2015

Correspondence Address:
Eman E Elzoghby
Department of Family Medicine, Damat Hospital Quotor Health Administration, Treat Alshiaty 31726, Tanta, Gharbia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163899

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  Abstract 

Objective
The aim of the study was to evaluate the quality of life (QoL) of asthmatic children and their parents and assess the effect of the disease on the QoL of their parents.
Background
Asthma is a public health problem that adversely affects different aspects of an individual's QoL. Childhood asthma is common in Egypt and is associated with repeated school absenteeism and hospital admission. The family and particularly the primary caregiver may face considerable burden.
Participants and methods
This is a case-control study carried out on 100 children with bronchial asthma, aged between 7 and 15 years, attending the Outpatient Clinic of the Pediatric Department of Menoufia University Hospital, and their primary caregivers. These children were compared with 100 control children whose diagnosis was free of bronchial asthma or any chronic diseases, as well as their primary caregivers. The following questionnaires were administered: the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire. In addition, the parents' socioeconomic level was determined.
Results
The scores of all parents and children in the study group were lower than the scores of controls. Parents' activity score and child's activity score were the most affected domains. There was significant relationship between the parents' score and child's score. The caregiver's and child's health-related QoL was significantly associated with each other. Age, sex, and socioeconomic status revealed no significant difference.
Conclusion
Childhood asthma significantly adversely affects the QoL of the affected children and their primary caregivers.

Keywords: caregivers, childhood asthma, quality of life


How to cite this article:
Elshazly HM, El Mahalawy II, Gabr HM, Abd El Naby SA, Elzoghby EE. Quality of life among asthmatic children attending the Outpatient Clinic in Menoufia University Hospital. Menoufia Med J 2015;28:442-6

How to cite this URL:
Elshazly HM, El Mahalawy II, Gabr HM, Abd El Naby SA, Elzoghby EE. Quality of life among asthmatic children attending the Outpatient Clinic in Menoufia University Hospital. Menoufia Med J [serial online] 2015 [cited 2020 Feb 26];28:442-6. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/442/163899


  Introduction Top


Pediatric asthma is a chronic inflammatory disease characterized by hyper-responsiveness of the lower airways and by variable airflow limitation. This disease can spontaneously remit or improve with treatment. Its clinical manifestations include recurrent episodes of wheezing, dyspnea, chest tightness, and cough, particularly at night and in the morning upon awakening [1] . Asthma puts a serious burden on the child's health-related quality of life (HRQoL), despite the availability of effective and safe treatment [2],[3],[4],[5] . The overall goal of asthma management is to achieve optimal disease control and HRQoL improvements [6],[7] . The use of HRQoL as an essential outcome measure of childhood asthma treatment and management has increased [8] . Poorly controlled asthma symptoms impair the HRQoL of children [9] .

The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was developed to measure the functional problems (physical, emotional, and social) that have the most impact on children (7-17 years) with asthma [10] .

With childhood asthma, the family and particularly the primary caregiver may face considerable burden. Although there are several questionnaires for assessing parental/caregiver's HRQoL not directly related to asthma [11] , there is only one instrument that examines the specific impact of childhood asthma on parental/caregiver functioning: the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) [12] .


  Participants and methods Top


Study design and population

This was a case-control study that comprised a convenience sample of 100 children with bronchial asthma (BA) and their primary caregivers (mothers, fathers, or the guardian of the child). They were recruited during the period from April 2013 to June 2014 and comprised 54 (54%) boys and 46 (46%) girls, their ages ranging from 7 to 15 years, with a mean of 11.08 years. These children attended the Outpatient Clinic of the Pediatric Department of Menoufia University Hospital, Menoufia governorate. They were compared with 100 control children and their primary caregivers, whose diagnosis was free of BA or any other chronic diseases. Bronchial asthma patient collected according to the definition of BA as a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm. The study protocol was approved by the Local Ethics Committee of Scientific Research, Faculty of Medicine, Menoufia University. Oral consent was obtained from all participants. The study objectives and tools were explained to the children and their caregivers, and they were reassured about the confidentiality of the study data.

Children between 7 and 15 years with severe asthma such as intermittent BA or with mild, moderate, or severe persistent asthma were selected for evaluation using the PAQLQ. Caregivers of these children were selected for administering the PACQLQ. Children with BA younger than 7 years of age or older than 15 years were excluded from the study. Those diagnosed with chronic respiratory and immune disorder such as bronchiolitis and interstitial pneumonia or with any chronic illness other than asthma, such as chest infection requiring antibiotic therapy, were excluded from the study.

Study measurements

Clinical evaluation

Patients were subjected to full medical history examination, including past, present, and family risk factor history. Data were collected on age, sex, diagnosis with special emphasis on the onset of the disease, duration, frequency, complications and treatment, and sleep pattern history with any sleep disorders. The sociodemographic characteristics of each patient were fully addressed.

Interviewer-administered questionnaires

The questionnaires were selected after a literature review that included the previously mentioned two questionnaires. The questionnaires were translated into the Arabic language and then validated.

The PAQLQ includes 23 items grouped into three domains: the 'symptoms' domain (10 items) (item nos 4, 6, 8, 10, 12, 14, 16, 18, 20, and 23), which includes wheezing, cough, and tiredness; the 'emotional function' domain (eight items) (item nos 5, 7, 9, 11, 13, 15, 17, and 21), which includes frustration, anger, and fear; and the 'activity limitations' domain (five items) (item nos 1, 2, 3, 19, and 22) [14] .

The PACQLQ includes 13 items, grouped into two domains [12] : the emotional function domain (items 1, 3, 5, 7, 9, and 10-13) and the activities domain (items 2, 4, 6, and 8).

The response options to all items are on a seven-point Likert scale, where 1 indicates maximum impairment and 7 indicates no impairment [15] . Individual items within the PAQLQ are equally weighted. Domain scores are expressed as the mean score per item for each of the domains as well as for overall QoL score. Overall QoL score is calculated from the mean score of all items and not from the mean of the domain [16] .

A pilot study was conducted for 3 months starting from 1 October 2013. It was performed on 20 patients who attended the Outpatient Clinic of the Pediatric Department, Menoufia University Hospital.

The aims of the pilot study were to:

  1. evaluate the adequacy and relevance of the validated questionnaires after translation with respect to the contents, language, and time consumption. A test-retest was done for testing the internal consistency of the questionnaires;
  2. to revise the file of each patient to know the type and availability of the recorded data; and
  3. to determine the time needed for filling every part of the questionnaires and explore the potential obstacles and difficulties that confront the execution and flow of work.
The parent's socioeconomic level was determined on the basis of five parameters (education, occupation, family size, family income, and crowdness of the house). The scores of all parameters were added and the parents were divided into three socioeconomic levels:

  1. High socioeconomic level; those with scores from 11 to 14.
  2. Middle socioeconomic level; those with scores from 8 to 10.
  3. Low socioeconomic level; those with scores below 8.
Obtaining information from both parents and caregivers may provide the most complete picture for HRQoL. All data were collected from the child or from his primary caregiver.

Statistical analysis

The data were tabulated and analyzed using the statistical package for the social sciences (SPSS, version 17; SPSS Inc., Chicago, Illinois, USA) (using an IBM personal computer).

Quantitative data were expressed as mean and SD (X ± SD) and analyzed applying the Student t-test. The independent t-test was used to compare data between two groups and one-way ANOVA was used when more than two groups were to be compared. The post-hoc test was used (using the LSD) to detect the difference between individual groups. Correlations between QoL scores and different study parameters were determined using Pearson's test.

Qualitative data were expressed as number and percentage and analyzed applying the χ2 -test.

  1. P value more than 0.05 was considered statistically nonsignificant.
  2. P value less than 0.05 was considered statistically significant.
  3. P value less than 0.01 was considered statistically highly significant.

  Results Top


Among the studied patients 54 (54%) were male and 46 (46%) were female; their ages ranged between 7 and 15 years with a mean of 11.08 years. Among the controls, 45% were male and 55% were female. There was no significant difference between asthmatic children and nonasthmatic children with respect to age (P = 0.904), sex (P = 0.203), and SES (P = 0.863). The SD was 3.03 years in cases of BA [Table 1].
Table 1 Socio-demographic characteristics of asthmatic child and control group

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The mean parent score was 39.58 and the mean child score was 77.42 in cases of BA. There was significant difference between cases and controls with respect to the mean parent score and mean child score, with lower scores in cases of BA (P < 0.001). Parent activity score was 11.78 (SD 3.75), parent emotional score was 21.90 (SD 7.73), child emotional score was 28.84 (SD 10.35), child activity score was 18.98 (SD 6.73), and the child symptom score was 26.16 (SD 9.42). There was significant difference between cases and controls with respect to all parent scores and all child scores (P < 0.001). The parent scores and child scores were lower among cases, with parent activity and child activity being the most affected domains [Table 2].
Table 2 Comparison between cases and controls regarding all child and parent scores

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There was a significant relationship between parent score and child score (P < 0.001; [Figure 1]. There was a nonsignificant relationship between child score and age of the child (P = 0.883) as well as between parent score and age of the child (P = 0.669) [Table 3].
Figure 1: Correlation between child score and parent score

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Table 3 Pearson's correlation between child score and parent score and age

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{Figure 1}

There was a nonsignificant difference between sex and socioeconomic status with respect to the parameters of age, parent score, child score, child emotional score, child activity score, child symptomatic score, parent emotional score, and parent activity score.


  Discussion Top


This study showed that there was a nonsignificant difference between children with BA and control children in terms of age, sex, and socioeconomic status, as shown in [Table 1]. The patients' overall age and different domains of child QoL scores (symptoms, activity, and emotional scores) and all scores of caregivers (activity and emotional scores) showed no significant difference between male and female participants. P value was greater than 0.05, which was considered statistically nonsignificant.

In this study no significant correlation existed between age and all child scores (P = 0.883) and parent scores (P = 0.669) [Table 3].

This was in agreement with the results of Reichenberg and Broberg [17] , who found that neither sex nor age of the child nor the socioeconomic index of the parent was related to PACQLQ scores.

Age and sex did not reveal any significant relationship with any of the PAQLQ scores [18] .

According to Reichenberg and Broberg, the overall score of activities, symptoms, and emotions was not different between boys and girls or between the upper and lower age groups. Sex seemed to be of little importance while the younger children reported more symptoms.

The overall score of PAQLQ was not statistically significantly different between boys and girls [19] .

In contrast, a previous study on asthmatic children found that the child's age and sex were the strongest independent determinants of QoL in asthmatic children [20] .

Parents of asthmatic children had significantly lower scores compared with parents of healthy children (P < 0.001). The parent emotional score and parent activity score were significantly lower among parents of asthmatic children than among parents of healthy children (P < 0.001). The parent activity score was the most affected [Table 2].

These results were in agreement with the Swedish version of the PACQLQ, which is suitable for exploring limitations in daily activities and emotional function. However, the heavily skewed distribution of scores, especially in the domain of activities [17] .

In contrast, emotional health appeared to be the most affected HRQoL in parents [21] .

This study demonstrated significantly lower scores for the child with BA compared with the healthy child. P value was less than 0.001 and was considered statistically highly significant. The activity score and emotional function score were lower in children with BA compared with the healthy child. P value was less than 0.001, which was considered statistically highly significant. The activity domain was the most affected, suggesting limitations in the medical service or noncompliance of patients, which is reflected in the level of control of their asthma and hence their symptoms, as shown in [Table 2].

Similarly, the activity domain was the most affected in previous studies measuring QoL among asthmatic children in Sweden [22] .

In other studies, the symptom domain was the most affected [23] .

In our study there a significant difference between child score and parent score as the parent score was affected by the child score. P value was less than 0.001, which was considered statistically highly significant, as shown in [Table 3].

Parents and primary caregivers of children with asthma have limitations in normal daily activities and experience anxieties and fears because of the child's illness [24] . The caregiver's and child's HRQoL is significantly associated with each other, although some studies have found no association between the caregiver's HRQoL and children's asthma symptoms [25] .

In this study there was a statistically nonsignificant correlation between SES and all child scores and parent scores, which is in accordance with the results of Leidy and Coughlin [26] , who did not find socioeconomic level to be a determinant of HRQoL in asthma, and similar to the results of Erickson et al. [27] , who showed that both asthma morbidity and HRQoL were related to socioeconomic status.


  Conclusion Top


Asthma affects the QoL of asthmatic children and the family, particularly that of the primary caregiver. Asthmatic children and their parents had lower scores in all domains, with child activity and parent activity being the most affected domains. Age, sex, and socioeconomic status revealed no significant difference.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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