Factors associated with poor health-related quality of life among patients with asthma: A hospital-based study from Jordan
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Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
College of Pharmacy, Al Ain University, Abu Dhabi, UAE
Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, JORDAN
Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, JORDAN
Online publication date: 2023-06-10
Publication date: 2023-09-01
Electron J Gen Med 2023;20(5):em517
Exploring the factors that are associated with diminished health-related quality of life (HRQOL) in patients with asthma is essential to reach the optimal HRQOL. This study aim to assess HRQOL and its associated factors in patients with asthma in Jordan.

This cross-sectional study was conducted on patients with asthma attending King Abdullah University Hospital and Jordan University Hospital in Jordan. In addition to socio-demographic variables, the study survey included mini asthma quality of life questionnaire (mini AQLQ) to measure HRQOL and asthma control test (ACT) to assess the degree of asthma control in asthmatic patients. Binary logistic regression was used to build a model of the independent predictors of poor HRQOL in the study participants.

Of the 314 participating patients, 70.1% were females, with a mean age of 51.47±16.37 years. 61.1% of the participants had low HRQOL, with a total mean mini AQLQ score of 4.30±1.30. Results revealed that advanced age (OR=0.961; 95% CI: 0.936-0.986; p<0.05) and lack of daily exercise (OR=0.233; 95% CI: 0.085-0.637; p<0.01) were significant predictors of poor HRQOL in patients with asthma, while better controlled disease, manifested by higher ACT score was associated with better HRQOL in these patients (OR=1.499; 95% CI: 1.344-1.672; p<0.01).

HRQOL represents an area for improvement in patients with asthma. The current study provides insight on the factors associated with poor HRQOL. Future interventions and asthma management programs should focus on improving asthma control and encouraging physical activity, particularly for older patients, with the aim of improving HRQOL among patients with asthma.

Goff S. Asthma facts and figures. Asthma and Allergy Foundation of America; 2022. Available at: https://www.aafa.org/asthma-fa... (Accessed: 17 June 2022).
World Health Organization. Asthma. Available at: https://www.who.int/news-room/... (Accessed: 17 June 2022).
Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258): 1204-22. https://doi.org/10.1016/S0140-... PMid:33069326.
Muhbes FJ, Alyeassery A. Asthma in adult patients: Stressors related to illness. Glob J Adv Pure Appl Sci. 2014;4:1-12.
Abu-Ekteish F, Otoom S, Shehabi I. Prevalence of asthma in Jordan: comparison between bedouins and urban schoolchildren using the international study of asthma and allergies in childhood phase III protocol. Allergy Asthma Proc. 2009;30(2):181-5. https://doi.org/10.2500/aap.20... PMid:19463207.
Higher Health Council. National strategy for health sector in Jordan. Available at: https://extranet.who.int/count... (Accessed: 10 April 2023).
Ismaila AS, Sayani AP, Marin M, Su Z. Clinical, economic, and humanistic burden of asthma in Canada: A systematic review. BMC Pulm Med. 2013;13(1):1-23. https://doi.org/10.1186/1471-2... PMid:24304726 PMCid:PMC4235031.
Alefan Q, Nawasrah A, Almomani B, Al-Issa ET. Direct medical cost of pediatric asthma in Jordan: A cost-of-illness retrospective cohort study. Value Heal Reg Issues. 2022;31:10-7. https://doi.org/10.1016/j.vhri... PMid:35313157.
Al-Motlaq MA, Al-Sheyab NA. Childhood asthma prevalence and severity in Zarqa City, Jordan. Jordan Med J. 2019;53(3):139-46.
Revicki DA, Kleinman L, Cella D. A history of health-related quality of life outcomes in psychiatry. Dialogues Clin Neurosci. 2014;16(2):127. https://doi.org/10.31887/DCNS.... PMid:25152652 PMCid:PMC4140507.
Ennaoui R, Turki M, Moussa N, et al. Quality of life in patients with asthma. Eur Psychiatry. 2016;33(S1):S377. https://doi.org/10.1016/j.eurp....
Albataineh E, Al-Zayadneh E, Abu- Lubad MA, Altarawneh A, Aldmour I. Determinants of low quality of life in asthmatic adult patients in South of Jordan. Biomed Pharmacol J. 2020;13(3):1439-50. https://doi.org/10.13005/bpj/2....
Zeru TG, Engidawork E, Berha AB. Assessment of asthma control and quality of life among asthmatic patients attending Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia. Pulm Med. 2020;2020:1-12. https://doi.org/10.1155/2020/5... PMid:32802503 PMCid:PMC7411494.
Ali R, Ahmed N, Salman M, Daudpota S, Masroor M, Nasir M. Assessment of quality of life in bronchial asthma patients. Cureus. 2020;12(10):e10845. https://doi.org/10.7759/cureus....
Gonzalez-Barcala FJ, De La Fuente-Cid R, Tafalla M, Nuevo J, Caamaño-Isorna F. Factors associated with health-related quality of life in adults with asthma. A cross-sectional study. Multidiscip Respir Med. 2012;7(5):1-10. https://doi.org/10.1186/2049-6... PMid:23031194 PMCid:PMC3489800.
Ilmarinen P, Juboori H, Tuomisto LE, Niemelä O, Sintonen H, Kankaanranta H. Effect of asthma control on general health-related quality of life in patients diagnosed with adult-onset asthma. Sci Rep. 2019;9(1):1-11. https://doi.org/10.1038/s41598... PMid:31695074 PMCid:PMC6834611.
Martínez-Moragón E, Palop M, de Diego A, et al. Factors affecting quality of life of asthma patients in Spain: The importance of patient education. Allergol Immunopathol (Madr). 2014;42(5):476-84. https://doi.org/10.1016/j.alle... PMid:24094444.
Kharaba Z, Feghali E, El Husseini F, et al. An assessment of quality of life in patients with asthma through physical, emotional, social, and occupational aspects. A cross-sectional study. Front Public Heal. 2022;10:1987. https://doi.org/10.3389/fpubh.... PMid:36117601 PMCid:PMC9477115.
Al-Kalaldeh M, Abd El-Rahman M, El-Ata A. Effectiveness of nurse-driven inhaler education on inhaler proficiency and compliance among obstructive lung disease patients: A quasi-experimental study. Can J Nurs Res. 2016;48(2):48-55. https://doi.org/10.1177/084456... PMid:28841042.
The Deutsche Atemwegsliga e.V. [German Airway League] correct inhalation technique. Available at: https://www.atemwegsliga.de/co... (Accessed: 28 April 2022).
Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR. Development and validation of the mini asthma quality of life questionnaire. Eur Respir J. 1999;14(1):32-8. https://doi.org/10.1034/j.1399... PMid:10489826.
Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: A survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59-65. https://doi.org/10.1016/j.jaci... PMid:14713908.
Schatz M, Mosen DM, Kosinski M, et al. Validity of the asthma control test completed at home. Am J Manag Care. 2007;13(12):661-7.
Lababidi H, Hijaoui A, Zarzour M. Validation of the Arabic version of the asthma control test. Ann Thorac Med. 2008;3(2):44-7. https://doi.org/10.4103/1817-1... PMid:19561904 PMCid:PMC2700459.
Green SB. How many subjects does it take to do a regression analysis. Multivariate Behav Res. 1991;26(3):499-510. https://doi.org/10.1207/s15327... PMid:26776715.
Bass P. Effects of asthma on your quality of life. Verywell health. Available at: https://www.verywellhealth.com... (Accessed: 17 June 2022).
Coban H, Aydemir Y. The relationship between allergy and asthma control, quality of life, and emotional status in patients with asthma: A cross-sectional study. Allergy Asthma Clin Immunol. 2014;10(1):1-7. https://doi.org/10.1186/s13223... PMid:25642249 PMCid:PMC4311476.
Oni OA, Erhabor GE, Oluboyo PO. Does health-related quality of life in asthma patients correlate with the clinical indices? South African Fam Pract. 2014;56(2):134-8. https://doi.org/10.1080/207862....
Song HJ, Blake K V., Wilson DL, Winterstein AG, Park H. Health-related quality of life and health utilities of mild, moderate, and severe asthma: Evidence from the medical expenditure panel survey. J Asthma Allergy. 2021;14:929-41. https://doi.org/10.2147/JAA.S3... PMid:34349523 PMCid:PMC8326771.
Ferreira LN, Brito U, Ferreira PL. Quality of life in asthma patients. Rev Port Pneumol. 2010;16(1):23-55. https://doi.org/10.1016/S0873-... PMid:20054507.
de Sousa JC, Pina A, Cruz AM, et al. Asthma control, quality of life, and the role of patient enablement: A cross-sectional observational study. Prim Care Respir J. 2013;22(2):181-7. https://doi.org/10.4104/pcrj.2... PMid:23603870 PMCid:PMC6442785.
Motaghi-Nejad M, Shakerinejad G, Cheragh M, Tavakkol H, Saki A. Quality of life in asthmatic patients. Int J Bioassays. 2015;4(3):3757-62.
Sundh J, Wireklint P, Hasselgren M, et al. Health-related quality of life in asthma patients–A comparison of two cohorts from 2005 and 2015. Respir Med. 2017;132:154-60. https://doi.org/10.1016/j.rmed... PMid:29229090.
Kannan JA, Bernstein DI, Bernstein CK, et al. Significant predictors of poor quality of life in older asthmatics. Ann Allergy Asthma Immunol. 2015;115(3):198. https://doi.org/10.1016/j.anai... PMid:26208758 PMCid:PMC4567431.
Al-Akour N, Khader YS. Quality of life in Jordanian children with asthma. Int J Nurs Pract. 2008;14(6):418-26. https://doi.org/10.1111/j.1440... PMid:19126069.
Stupka E, deShazo R. Asthma in seniors: Part 1. Evidence for underdiagnosis, undertreatment, and increasing morbidity and mortality. Am J Med. 2009;122(1):6-11. https://doi.org/10.1016/j.amjm... PMid:19114162.
Talreja N, Baptist AP. Effect of age on asthma control: Results from the national asthma survey. Ann Allergy Asthma Immunol. 2011;106(1):24-9. https://doi.org/10.1016/j.anai... PMid:21195941.
Tsai CL, Lee WY, Hanania NA, Camargo CA. Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008. J Allergy Clin Immunol. 2012; 129(5):1252-8. https://doi.org/10.1016/j.jaci... PMid:22385630.
Tsai CL, Delclos GL, Huang JS, Hanania NA, Camargo CA. Age-related differences in asthma outcomes in the United States, 1988-2006. Ann Allergy Asthma Immunol. 2013; 110(4):240-6. https://doi.org/10.1016/j.anai... PMid:23535086.
Mirany M. The role of exercise in stress management. The American Institute of Stress; 2020. Available at: https://www.stress.org/the-rol... (Accessed: 23 June 2022).
Basso RP, Jamami M, Labadessa IG, et al. Relationship between exercise capacity and quality of life in adolescents with asthma. J Bras Pneumol. 2013;39(2):121-7. https://doi.org/10.1590/S1806-... PMid:23670496 PMCid:PMC4075832.
Pacheco DRR, Silva MJB, Alexandrino AMS, Torres RMT. Exercise-related quality of life in subjects with asthma: A systematic review. J Asthma. 2012;49(5):487-95. https://doi.org/10.3109/027709... PMid:22554022.
Avallone KM, McLeish AC. Asthma and aerobic exercise: a review of the empirical literature. J Asthma. 2013;50(2): 109-16. https://doi.org/10.3109/027709... PMid:23252987.
Lang JE. The impact of exercise on asthma. Curr Opin Allergy Clin Immunol. 2019;19(2):118-25. https://doi.org/10.1097/ACI.00... PMid:30601152.
Almomani BA, Al-Sawalha NA, Samrah SM, Gamble JM, Al Momani MA. Asthma insights from Jordan: Cross-sectional observational study. J Asthma. 2016;53(4):349-55. https://doi.org/10.3109/027709... PMid:26666170.
Belachew EA, Sendekie AK, Tadess S, Alemayehu M. Health-related quality of life and its associated factors among patients with asthma: A multi-centered cross-sectional study in selected referral hospitals in Northwest Ethiopia. PLoS One. 2023;18(2):e0281742. https://doi.org/10.1371/journa... PMid:36787327 PMCid:PMC9928093.
Terzano C, Cremonesi G, Girbino G, et al. 1-year prospective real life monitoring of asthma control and quality of life in Italy. Respir Res. 2012;13:1-11. https://doi.org/10.1186/1465-9... PMid:23216798 PMCid:PMC3546892.
Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: The asthma insights and reality in Europe (AIRE) study. Eur Respir J. 2000;16(5):802-7. https://doi.org/10.1183/090319... PMid:11153575.
Micheletto C, Visconti M, Tognella S, Facchini F, Dal Negro R. Aspirin induced asthma (AIA) with nasal polyps has the highest basal LTE4 excretion: A study vs AIA without polyps, mild topic asthma, and normal controls. Eur Ann Allergy Clin Immunol. 2006;38(1):20-3.
Aburuz S, Gamble J, Heaney L. Assessment of impairment in health-related quality of life in patients with difficult asthma: Psychometric performance of the asthma quality of life questionnaire. Respirol. 2007;12(2):227-33. https://doi.org/10.1111/j.1440... PMid:17298455.
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