Health‐related quality of life burden in severe asthma

McDonald, Vanessa M.; Hiles, Sarah A.; Jones, Kimberley A; Clark, Vanessa; Yorke, Janelle

doi:10.5694/mja18.00207

Cited by 75 publications

(63 citation statements)

References 71 publications

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“…Preserving the “self” in severe asthma becomes harder when there is a constant struggle to fight the debilitating physical effects of the illness and side‐effects of its treatment, and the identifications that come with the diagnosis. When trying to maintain and preserve “self” in the face of illness, individuals acknowledged the emotional cost associated with their efforts in preserving “normality.” Previous quantitative and qualitative researches on patients’ experiences with severe asthma note that its debilitating and unpredictable symptoms, the side‐effects of treatment and the burden on their quality of life can ultimately have emotional consequences, but there is a lack of in‐depth psychological research furthering our understanding of how people living with severe asthma perceive their condition and how they behave when challenged in a range of situations. Our findings attempt to broaden and challenge the biomedical model, and highlight that asserting autonomy to preserve their sense of “normality” and sense of self might also lead to unwanted outcomes.…”

Section: Discussionmentioning

confidence: 99%

The impact of severe asthma on patients’ autonomy: A qualitative study

Eassey

Reddel

Ryan

et al. 2019

Health Expectations

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Background People living with severe asthma may have ongoing debilitating symptoms despite high‐dose treatment. Clinical guidelines for severe asthma recommend concepts such as patient centeredness, shared decision making and self‐management, at the heart of which lies autonomy. Objective This study aimed to explore the role of autonomy in patients’ narratives about their experiences of living with and managing severe asthma. Methods In‐depth semi‐structured interviews were video‐ and/or audio‐recorded and transcribed. Data were categorized using a hybrid approach to analysis incorporating both inductive and deductive methods, informed by the self‐determination construct of autonomy. Analysis and comparison across and within categories were conducted to develop final themes. Results Twenty‐nine face‐to‐face interviews, lasting 1.5‐4 hours, were conducted across Australia. Patients’ autonomy was enacted or challenged in a range of situations, such as interacting with health‐care providers, maintaining employment, managing symptoms, and dealing with threats to self‐identity. Two main themes were discerned from the analysis: (a) the desire to live an “unconstrained” life; and (b) preservation of self‐identity. Conclusion Our findings suggest that autonomy is broader than conventional medical concepts such as decision making and information seeking. Future research should consider these findings when developing and implementing patient‐driven self‐management interventions for those living with severe asthma.

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Section: Discussionmentioning

confidence: 99%

The impact of severe asthma on patients’ autonomy: A qualitative study

Eassey

Reddel

Ryan

et al. 2019

Health Expectations

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“…Whilst most patients with asthma can expect to be well controlled with inhaled corticosteroids and bronchodilators [1], there remains a small group of patients, estimated to account for 5-10% of adults with asthma, with more refractory, severe disease [2]. These patients have daily symptoms that limit their quality of life, and they have frequent exacerbations which result in lost productivity and increased healthcare utilisation [3]. There are limited therapeutic options for such patients who often find themselves treated with chronic oral steroids with all the attendant steroid related side effects [4].…”

Section: Introductionmentioning

confidence: 99%

Bronchial thermoplasty increases airway volume measured by functional respiratory imaging

et al. 2019

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Background: The purpose of this study was to use CT scanning with computational fluid dynamics to evaluate the mechanisms by which Bronchial Thermoplasty (BT) improves asthmatic symptoms. Methods: The study was conducted in a university teaching hospital, experienced in performing BT. Imaging studies were performed before, and after, BT of the left lung, and prior to treatment of the right lung, which therefore acted as a control. On each occasion, two high-resolution CT scans were performed, one at full inspiration (TLC) and the other at Functional Residual Capacity (FRC). The study protocol was offered to 10 patients, all of whom met the definition of severe asthma, despite high dose inhaled corticosteroids and dual long acting bronchodilators. Results: Significant increases in airway luminal volume were observed on the treated side, compared with control, at both full inspiration (by 27%) and at FRC (by 17%). The ratio of distal airway volume to lung volume significantly increased on the treated side. The change in airway volume with inspiration from FRC increased by 48% on the treated side compared to 5% in the control lung, suggesting treatment increased airway distensibility. No effect was observed on airway wall thickness, nor air trapping. There was a trend towards correlation between the improvement in airway volume at TLC and improvement in symptoms. Conclusion: This study demonstrates that BT increases the luminal airway volume on the treated side compared to the control lung. We suggest that this is an important link between the airway smooth muscle atrophy demonstrated pathologically, and the improvement in symptoms observed clinically.

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“…It could be hypothesised that the nurse-led assessment was an effective means to identify treatment difficulties more effectively. Indeed the "simple" steps of checking for adherence to therapy concurrent with asthma education can markedly improve asthma control and promote a better quality of life for some patients [8,26,27]. Our analysis was not appropriately controlled to provide high-level evidence for a beneficial effect of a nurse-led SAC on outcomes.…”

Section: Discussionmentioning

confidence: 95%

Clinical and lung function outcomes in a cohort of children with severe asthma

et al. 2020

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Background: Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC). Methods: This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate. Results: Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%). Conclusion: Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.

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Health‐related quality of life burden in severe asthma

Cited by 75 publications

References 71 publications

The impact of severe asthma on patients’ autonomy: A qualitative study

The impact of severe asthma on patients’ autonomy: A qualitative study

Bronchial thermoplasty increases airway volume measured by functional respiratory imaging

Clinical and lung function outcomes in a cohort of children with severe asthma

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