Renzi-Lomholt Martino, Håkansson Kjell Erik Julius, Suppli Ulrik Charlotte
Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Eur Clin Respir J. 2022 Nov 24;10(1):2149920. doi: 10.1080/20018525.2022.2149920. eCollection 2023.
Poor asthma control, often caused by non-adherence with controller medication, is a well-known risk factor for impaired quality of life (QoL) and major mood disorders (MMD). Previous studies have shown a relationship between non-adherence, lower QoL, and MMD across chronic diseases, but the relationship remains uncertain in asthma.
All asthma patients followed at the respiratory outpatient clinic at Copenhagen University Hospital - Hvidovre were invited to fill-in the Hospital Anxiety and Depression Scale (HADS) and the Mini Asthma Quality of Life Questionnaire (miniAQLQ). Medication Possession Ratio (MPR) was calculated using pharmacy redemption data. Relationships between questionnaire scores, inhaled corticosteroid MPR and use of rescue medication were investigated using Pearson correlation and multivariable linear regression adjusted for age, sex, FEV, and GINA Step. Data from scheduled visits were collected from patients' medical records.
A total of 308 patients (73% females, median age 51 years (interquartile range (IQR) 37, 62)) completed the questionnaires and had 1-year medication data available. Median adherence to inhaled corticosteroids (ICS) was 57% (35%, 75%) with 18% of patients having adherence above 80%. Of the participating patients, 14% and 27% reported depressive and anxiety-related symptoms, respectively, and 72% reported impaired QoL. In correlation analyses, ICS adherence was not significantly associated with either prevalence of MMD symptoms or impaired QoL in asthma patients. However, a strong correlation was found between ACQ-6 and both MMD symptoms and impaired QoL, as well as between rescue medication use and impaired QoL. In adjusted analysis, however, the latter correlation was no longer statistically significant.
Our results suggest that ICS adherence is not directly correlated with either impaired quality of life or major mood disorder symptoms in asthma patients. Self-reported asthma control, on the other hand, is strongly correlated with both QoL and MMD.
哮喘控制不佳通常由未坚持使用控制药物引起，是生活质量受损（QoL）和重度情绪障碍（MMD）的一个众所周知的危险因素。先前的研究表明，在各种慢性疾病中，不依从、较低的生活质量和重度情绪障碍之间存在关联，但在哮喘中这种关系仍不确定。
邀请哥本哈根大学医院-维德奥弗呼吸门诊随访的所有哮喘患者填写医院焦虑抑郁量表（HADS）和哮喘生活质量简易问卷（miniAQLQ）。使用药房配药数据计算药物持有率（MPR）。使用Pearson相关性分析以及针对年龄、性别、第一秒用力呼气容积（FEV）和全球哮喘防治创议（GINA）分级进行调整的多变量线性回归，研究问卷得分、吸入性糖皮质激素MPR与急救药物使用之间的关系。定期就诊的数据从患者病历中收集。
共有308名患者（73%为女性，中位年龄51岁（四分位间距（IQR）37，62））完成了问卷并提供了1年的用药数据。吸入性糖皮质激素（ICS）的中位依从率为57%（35%，75%），18%的患者依从率高于80%。在参与研究的患者中，分别有14%和27%报告有抑郁和焦虑相关症状，72%报告生活质量受损。在相关性分析中，ICS依从性与哮喘患者的重度情绪障碍症状患病率或生活质量受损均无显著相关性。然而，发现哮喘控制问卷-6（ACQ-6）与重度情绪障碍症状和生活质量受损之间以及急救药物使用与生活质量受损之间存在强相关性。然而，在调整分析中，后一种相关性不再具有统计学意义。
我们的结果表明，ICS依从性与哮喘患者的生活质量受损或重度情绪障碍症状均无直接相关性。另一方面，自我报告的哮喘控制情况与生活质量和重度情绪障碍均密切相关。
