Helene Favreau

Association of Asthma Self-efficacy to Asthma Control and Quality of Life

BackgroundAchieving optimal asthma control relies upon several behavioral factors (self-monitoring, treatment adherence) that may be influenced by asthma self-efficacy (ASE).PurposeTo assess the extent to which levels of ASE are associated with asthma control and asthma-related quality of life in patients with asthma.MethodsA total of 557 adult patients with documented asthma completed a battery of questionnaires (Asthma Self-Efficacy Scale, ASES; Asthma Control Questionnaire, ACQ; Asthma Quality of Life Questionnaire, AQLQ) and standard spirometry. Patients also underwent a sociodemographic, medical history, and psychiatric interview. Partial correlations adjusting for covariates were conducted to assess associations between ASES scores and ACQ and AQLQ scores.ResultsResults indicated that ASES scores were negatively correlated with ACQ total score and individual items scores, indicating that higher levels of ASE were associated with improved asthma control, and positively correlated with AQLQ total and subscale scores, indicating that higher levels of ASE were associated with better asthma-related quality of life. All findings were independent of covariates.ConclusionsFindings suggest that being confident in one’s ability to control asthma symptoms is associated with better asthma control and quality of life. Future studies should assess the direction of the association between self-efficacy and asthma morbidity in order to determine optimal treatment targets.

Prospective impact of panic disorder and panic-anxiety on asthma control, health service use, and quality of life in adult patients with asthma over a 4-year follow-up.

Background Panic disorder (PD) is a common anxiety disorder among asthmatic patients with overlapping symptoms (e.g., hyperventilation). However, the longitudinal impact of PD on asthma control remains poorly understood. This study assessed the impact of PD and panic-anxiety on asthma control over a 4.3-year follow-up in 643 adult asthmatic patients. Methods Consecutive patients presenting to a tertiary asthma clinic underwent a sociodemographic, medical history, and psychiatric (Primary Care Evaluation of Mental Disorders) interview and completed questionnaires including the Anxiety Sensitivity Index (ASI) to assess panic-anxiety. At follow-up, patients completed the Asthma Control (ACQ) and Asthma Quality of Life (AQLQ) questionnaires and reported emergency department visits and hospitalizations during the follow-up. Results Baseline frequency of PD was 10% (n = 65). In fully adjusted models, analyses revealed that PD and ASI scores predicted worse follow-up ACQ total scores (&bgr; = 0.292, p = .037; &bgr; = 0.012, p = .003) but not AQLQ total scores. ASI scores also predicted greater nocturnal and waking symptoms, activity limitations, and bronchodilator use on the ACQ (&bgr; = 0.012–0.018, p < .05) as well as lower symptom (&bgr; = −0.012, p = .006) and emotional distress (&bgr; = −0.014, p = .002) subscale scores on the AQLQ. Neither PD nor ASI scores were associated with hospitalizations, although ASI scores (but not PD) were associated with an increased risk of emergency department visits (relative risk = 1.023, 95% confidence interval = 1.001–1.044). Conclusions PD and anxiety sensitivity are prospectively associated with poorer asthma control and may be important targets for treatment.

Effect of an integrated care programme on re‐hospitalization of patients with chronic obstructive pulmonary disease

Background and objective:  Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1‐year integrated care (IC) programme comprising two components (patient‐centred education + case management) would be effective in preventing COPD‐related hospitalizations.

Can a self-management education program for patients with chronic obstructive pulmonary disease improve quality of life ?

OBJECTIVE To assess the effects of a self-management program on health-related quality of life (HRQoL) and morbidity commonly associated with chronic obstructive pulmonary disease (COPD). METHODS A total of 57 outpatients with stable COPD received four weeks of self-management education, while 45 patients received usual care. Patients were evaluated at baseline, at three months and one year following the educational intervention. The primary outcome variable was HRQoL measured by the St Georges Respiratory Questionnaire (SGRQ). The secondary outcome variables were number of emergency room visits and hospitalizations for exacerbation. RESULTS The intervention groups HRQoL improved significantly at three months (total score A = -5.0 [P = 0.006]) and 12 months (total score A = -6.7 [P < 0.001]), as evidenced by decreased scores on the SGRQ. In contrast, the SGRQ scores increased significantly in the control group at three months (total score A = +3.7 [P = 0.022]) and 12 months (total score A = +3.4 [P = 0.032]). Global impact appeared to be responsible for the change in the intervention group. Moreover, in the intervention group, the number of hospitalizations dropped from 0.7⁄person⁄year to 0.3⁄person⁄year (P = 0.017), and emergency room visits dropped from 1.1 person⁄year to 0.2⁄person⁄year (P = 0.002), while subjects in the control group did not experience any significant decreases in these parameters. CONCLUSIONS A planned education program improved HRQoL while decreasing the number of emergency room visits and hospitalizations in patients with stable COPD; this improvement persisted at 12 months.

Does a Self-management Education Program Have the Same Impact on Emotional and Functional Dimensions of HRQoL?

Abstract Most previous research evaluating the effect of interventions on HRQoL in COPD patients has focused on measuring HRQoL using aggregated questionnaire scores, increasing the risk of false-negative results. There is also evidence to suggest that self-evaluations of functional status are less likely to be modified over time relative to self-evaluation of emotional status. This study was a secondary analysis of a prospective study that compared the efficacy of a self-management education program (SM) on emotional and functional dimensions of HRQoL. One hundred and ten patients were recruited from the Sacré-Coeur Hospital of Montreal (Canada). Patients were included in either the SM group (n = 60) or the usual-care group (UC, n = 50). The SM group underwent a 4-week intervention based on content featured in “Living Well with COPD” program. Patients were assessed pre and 12-months post-intervention; the primary outcome was net change in the emotional and functional subscales scores of the St-Georges Respiratory Questionnaire (SGRQ) and Short-Form health survey questionnaire (SF-36). Only the emotional dimension scores of both the SGRQ (impact) and the SF-36 (mental component summary) were statistically and clinically improved in the SM group compared to UC. Also, the 12-month adjusted between-group difference in the SGRQ-impact scores was 3-fold higher than the minimum clinically important difference in SM vs. UC patients. HRQoL needs to be regarded as a combination of distinct self-evaluations with unique dynamics over time. This distinction should be taken into account in program development and evaluation, to choose intervention components likely to impact on both types of self-evaluations related to HRQoL.

Prospective Impact of Psychiatric Disorders on Employment Status and Health Care Use in Patients Investigated for Occupational Asthma

Objective: We previously reported high rates (34%) of psychiatric disorders (PSY) in patients evaluated for occupational asthma (OA). We determined the impact of PSY on employment status and health care use 12 to 18 months later. Methods: One hundred ninety-six patients underwent clinical and psychiatric interviews on the day of their OA evaluation. Patients were re-contacted 12to 18 months later to assess employment status and health care use. Results: Results indicated that patients with a PSY at baseline were less likely to be employed (adjusted odds ratio = 2.88; 95% confidence interval = 1.29 to 6.44) irrespective of final medical diagnosis (including OA), and had higher rates of emergency visits (35% vs 19%, P = 0.04). Conclusion: Psychiatric morbidity is common in this population and associated with lower employment rates and greater use of emergency services. Greater efforts should be made to assess and treat PSY in this population.