You are on page 1of 19

Measuring Disease Burden:

Asthma caregiver quality of life

Ana Kobayashi
Maternal and Child Health Program
June 7, 2006


is a major public health problem

facing children and families.


is a common chronic childhood

illness, leading to 14 million missed
school days each year.


asthma also affects the well being

(National Center for Environmental Health of the Centers of Disease Control
and Prevention, 2005) (Institute of Medicine, 2000)

Asthma Caregiver Quality of Life


Pediatric Asthma Caregiver Quality

of Life Questionnaire (PACQLQ)
measures how a childs asthma affects


item questionnaire asking caregivers

about their activities and feelings.

(Juniper et al., 1996b)

Literature Review

QOL studies find that AQLQ

scores are related to:
Asthma severity
Environmental tobacco smoke (ETS)
Education and income
Female gender (inconsistently)
Hispanic race/ethnicity

(Leidy et al., 1998a, Leidy et al., 1998b;Eisner et al, 2002;Sippel et al., 1999) (Adams
et al., 2004; Apter et al, 1999; von Rueden et al., 2006)

Literature Review

Few studies have investigated predictors of

caregiver QOL, and indicate caregiver QOL is
associated with:

Child symptom free days and symptom frequency

Caregivers perception of disease control
Use of maintenance medication
Smoking household
Hispanic ethnicity

(Halterman et al., 2004; Levy et al., 2004)

Study Objective
To evaluate

relationships between caregiver

QOL and health utilization, asthma
management, and other variables in a
community sample.

Setting: Clean Air for Kids

Clean Air for Kids Partnership (CAFK) is a

program designed to help caregivers of children
with asthma learn how to manage asthma at home
and how to reduce environmental exposures.

Caregivers of children with asthma who live in

Pierce County, Washington reach the program
through community-, physician-, school-, and self
- referral.

(Primomo, Johnston, DiBiase, Nodolf & Noren, 2006)


Secondary data analysis

Data was collected during CAFK program

evaluation, consisting of baseline caregiver
survey responses.

Linear regression was used to evaluate

associations between independent and outcome
variables and to generate three linear regression


Associations between independent

variables and PACQLQ, Emotional function,
and Activity limitation scores.
Three stepwise linear regression models for
each: PACQLQ, Emotional function, and
Activity limitation scores.


Asthma Severity
Missed School
ER visits

Asthma Severity
Missed School
ER visits


Asthma Severity
Missed School
ER Visits
Child Age

TABLE 3: Stepwise regression models predicting baseline PACQLQ scores.

Quality of Life Emotional Function Activity Limitation
Summary Score Subscale score ( )
subscale score ( )
Model 1
Perceived asthma
Overall Model R2
Model 2
Perceived asthma
ER Visits
Overall Model R2
Model 3
Perceived asthma
ER visits
Caregiver education
Overall Model R2
* = p < 0.05
** = p < 0.01
*** = p < 0.001

- 0.48*

- 0.42*

- 0.61**




- 0.30

- 0.26

- 0.37

- 0.12**

- 0.10

- 0.16**

- 0.29

- 0.26

- 0.37

- 0.12**

- 0.99*

- 0.16**
Not included

Implications for practice

Interventions proven to reduce emergency

health services utilization should be used to
support increased caregiver quality of life.

Future studies should further investigate

relationships between demographic
characteristics of families and caregiver
quality of life.


Clean Air for Kids Partnership

Janet Primomo RN, PhD.
Marcia Williams PhD., MPH.
Supported in part by Project #T76 MC 00011
from the Maternal and Child Health Bureau
(Title V, Social Security Act),
Health Resources and Services Administration,
U.S. Department of Health and Human Services.

Adams R.J., Wilson D., Smith B.J., & Ruffin R.E. (2004) Impact of coping
and socioeconomic factors on quality of life in adults with asthma.
Respirology 9: 87-95.
Adams R.J., Appleton S., Wilson D.H., & Ruffin R.E. (2005) Participatory
decision making, asthma action plans, and use of asthma medication: A
population survey. Journal of Asthma, 42:673 678.
Apter A.J., Reisine S.T., Affleck G., Barrows E., & ZuWallack R.L. (1999)
The influence of demographic and socioeconomic factors on health related
quality of life in asthma. J Allergy Clin Immunol, 103(1): 72 78.
Barnes N.C., & Williams A.E. (2005) Unscheduled healthcare resource use
among asthma patients receiving low dose inhaled corticosteroids
maintenance treatment. Int J Clin Pract, 59(9): 1017 1024.
Eisner M.D., Yelin E.H., Katz P.P, Earnest G & Blanc P.D. (2002). Exposure to
indoor combustion and adult asthma outcomes: Environmental tobacco
smoke, gas stoves, and woodsmoke. Thorax, 57: 973-978.

Erickson S.R., Christian Jr. R.D., Kirking D.M., & Halman L.J. (2002)
Relationship between patient and disease characteristics, and helath related
quality of life in adults with asthma. Respiratory Medicine, 96: 450-460.
Halterman J.S., Yoos H.L., Conn K.M., Callahan P.M., Montes G., & et al. (2004)
The Impact of childhood asthma on parental quality of life. Journal of Asthma
41(6): 645-653.
Institute of Medicine (IOM) (U.S.). (2000). Clearing the air: asthma and indoor
air exposures. Washington, D.C: National Academy Press.
Juniper E.F., Guyatt G.H., Feeny D.H., Ferrie P.J., Griffith L.E. & Townsend M.
(1996a). Measuring quality of life in children with asthma. Quality of Life
Research 5: 35-46.
Juniper E.F., Guyatt G.H., Feeny D.H, Ferrie P.J., Griffith L.E, & Townsend M.
(1996b) Measuring quality of life in the parents of children with asthma.
Quality of Life Research 5: 27-34.
Krieger J.W., Takaro T.K., Song L., & Weaver M. (2005) The Seattle King
County Healthy Homes Project: A randomized, controlled trial of a community
health worker intervention to decrease exposure to indoor asthma triggers.
American Journal of Public Health, 95(4): 652 659.

Kurnat E.L., Moore C.M. (1999) The impat of a chronic condition on the
families of children with asthma. Pediatric Nursing, 25 (3): Career and
Technical Education pg 288.
Leidy N.K, Chan K.S., & Coughlin C. (1998) Is the asthma quality of life
questionnaire a useful measure for low income asthmatics? Am J Respir Crit
Care Med 158: 1082-1090.
Leidy N.K., & Coughlin C. (1998) Psychometric performance of the Asthma
Quality of Life Questionnaire in a US sample. Quality of Life Research 7:
Leung R., Koenig J.Qu., Simcox N., van Belle G., Fenske R., & Gilbert S.G.
(1997) Behavioral changes following participation in a home health
promotional program in King County, Washington. Environ Health Perspect.
105(10): 1132-5.
Levy J.I., Welker Hood L.K., Clougherty J.E., Dodson R.E., Steinbach S., & et
al. (2004) Lung function, asthma symptoms, and quality of life for children in
public housing in Boston: a case series analysis. Environmental health: A
Global Access Science Source 3 (13).

Medical Assistance Administration. (2005). Medical Eligibility Overview.
Accessed online May 2006 at http://fortress.wa.
gov/dshs/maa/eligibility/OVERVIEW/MedicalOverviewChildrens .htm.
Meszaros A, Zelko R, Mesko A, & Vincze Z. (2005) Factorial design for the
analysis of patients quality of life in asthma. Qual Life Res 14: 191-195.
National Asthma Education and Prevention Program (NAEPP). (2002). National
Asthma Education and Prevention Program Expert Panel Report: Guidelines for
the Diagnosis and Management of AsthmaUpdate on Selected Topics 2002.
(2002). National Heart, Lung, and Blood Institute, National Institutes of Health,
NIH Publication No. 97-4051: Bethesda, MD. Retrieved September 19, 2005
from .htm
National Asthma Education and Prevention Program (NAEPP). (2006). National
Asthma Education and Prevention Program: Program Description. Accessed
online May 2006 at:
National Center for Environmental Health of the Centers for Disease Control and
Prevention. (2005) Asthma's Impact on Children and Adolescents." Retrieved
June 2005, from:

Primomo J., Johnston S., DiBiase F., Nodolf J., & Noren L. (2006). Evaluation
of a community based outreach worker program for children with asthma.
Public Health Nursing, 23(3): 234 - 241.
Schatz M, Mosen D, Apter A.J., Zeiger R.S., Vollmer W.M, et al. (2005)
Relationships among quality of life, severity, and control measures in asthma:
An evaluation using factor analysis. J Allergy Clin Immunol, 115(5): 10491055.
Sippel J.M., Pedula K.L, Vollmer W.M., Buist A.S., & Osborne M.L. (1999).
Associations of smoking with hospital - based care and quality of life in
patients with obstructive airway disease. Chest, 115: 691 - 696
von Rueden U., Gosch A., Rajmil L., Bisegger C., Ravens Sieberer U., & the
European Kidscrren group. (2006) Socioeconomic determinants of health
related quality of life in childhood and adolescence: Results from a European
study. J. Epidemiol. Community Health, 60: 130-135.