Original Articles: Asthma Lower Airway Diseases
The impact of inadequately controlled asthma in urban children on quality of life and productivity

https://doi.org/10.1016/S1081-1206(10)60713-2Get rights and content

Background

The burden of inadequately controlled pediatric asthma on education and other daily activities is not well described.

Objective

To evaluate asthma-related activity limitations and productivity losses among children and caregivers.

Methods

Surveys were mailed to caregivers of children with asthma. Caregivers provided demographics, health-related quality of life (HRQL), workplace productivity, and asthma-related costs. Adolescents (aged 12-18 years) provided HRQL, asthma control, and school-based productivity, and young children (aged 4-11 years) completed an asthma control questionnaire with help from a caregiver.

Results

Among the 239 respondents, the mean age was 10.1 years; 49% were girls. More than half were inadequately controlled as measured using the Asthma Control Test. Both HRQL and productivity were significantly lower in patients with inadequately controlled asthma compared with those with controlled asthma. In the previous year, caregivers reported missing 1.4 days of work due to their child's asthma, with the child missing an average of 4.1 school days. Fewer adolescents with controlled asthma reported missing 1 or more school days in the previous week compared with adolescents with inadequately controlled asthma (3.5% vs 34.0%; P < .001). There were similar differences in caregiver workdays missed and health care resource use: both were significantly higher in children with inadequately controlled asthma.

Conclusions

Inadequately controlled asthma has a significant impact on asthma-specific HRQL, school productivity and attendance, and work productivity of children and their caregivers.

Section snippets

INTRODUCTION

Among school-aged children in the United States, the prevalence of asthma is estimated to be approximately 10%, and the annual cost is $3.2 billion.1 Children miss 14 million school days annually due to asthma according to the National Center for Health Statistics.2 Children with asthma miss an average of 1.5 school days annually.3 Particular asthma symptoms have been linked to school absences. Children who experience nocturnal asthma awakenings 1 to 3 days per week were 3.6 times more likely

Study Design

A cross-sectional cohort study was conducted between September 1, 2005, and December 31, 2005, in a clinical research center associated with The Johns Hopkins University (Baltimore, MD). Children were identified from an existing list of pediatric asthmatic patients who had participated in previous studies. The study received institutional review board approval from The Johns Hopkins University before initiation. Participant consent was obtained in writing.

Adolescent asthmatic patients (aged

RESULTS

Study results were based on 239 children with asthma, including 131 young children 4 to 11 years of age and 108 adolescents 12 to 18 years of age. Demographic characteristics of the patients and their parents or caregivers are given in Table 1, and clinical characteristics of the patients are given in Table 2. The mean ± SD patient age was 10.1 ± 3.6 years, and 49% were girls. Approximately 70% of the patients were African American, and 98% had health insurance, including private and public

DISCUSSION

This study demonstrates substantial effects on quality of life, school and work attendance, resource use, and costs among children with inadequately controlled asthma and their caregivers. Children with inadequately controlled asthma demonstrated greater impairment in quality of life, decreased school attendance, loss of work by the caregiver, reports of diminished productivity while at school, and increased health care resource use and costs to the family. Taken together, these results

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    This study was supported by GlaxoSmithKline.

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