Effect of Bronchial Asthma on Quality of Life among Patients Attending Family Medicine Clinics in Saudi Arabia

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1 Med. J. Cairo Univ., Vol. 85, No. 2, March: , Effect of Bronchial Asthma on Quality of Life among Patients Attending Family Medicine Clinics in Saudi Arabia MANA M. AL-SHAHRANI, M.B.B.S. 1 ; SALEH O. BAJAHLAN, M.B.B.S. 2 ; ZIAD N. AL-JAZI, M.B.B.S. 3 ; SULTAN M. AL-AHMARI, M.B.B.S. 4 ; HANI S. AL-SHEHRI, M.B.B.S. 5 ; MOUSA M. HADI, M.B.B.S. 5 ; SALMAN A. AL-OTIFI, M.B.B.S. 5 and AHMED ABOU EL-YAZID, Dr.Ph. 6 The Department of Family Medicine Resident, King Faisal Medical City, Southern Region, Saudi Arabia 1, Gernate PHC Center, Riyadh 2, Prince Mutiab Bin Abdulaziz Hospital, Skaka 3, Resident, Armed Forces Hospitals, Southern Region, Saudi Arabia 4, PHC Center, Ministry of Health, Saudi Arabia 5 and the Department of Community Medicine, Mansoura University, Egypt & Preventive Medicine Armed Forces Hospitals, Southern Region, Saudi Arabia 6 Abstract Objectives: To assess the effect of bronchial asthma on Quality of the Life (QOL) of Methodology: A cross sectional study was conducted on 380 bronchial asthma patients January and June 2016 at the Chronic Diseases Clinic in Ahad Rufaidah Family Medicine Center and the Asthma Clinic at the Armed Forces Hospital, Khamis Mushait, Saudi Arabia. Using a self-administrated questionnaire. Results: Of 380 patients (males 45.3% and females 54.7%) there were low mean scores for all. No significant relation between age groups and in bronchial asthma Female, non-married and those living in urban areas had lower QOL scores. The higher frequency of occurrence of bronchial asthma attacks was associated with lower QOL scores. Conclusions: QOL of bronchial asthma patients is low. QOL is more affected among females, non-married patients living in rural areas, and those with more frequency of asthmatic attacks. Therefore, physicians should routinely assess QOL among their asthmatic Limitations in patients' quality of life, indicate that asthma is not well controlled. Key Words: Bronchial asthma Quality of life Risk factors. Introduction BRONCHIAL asthma is one of the most common chronic illnesses in Saudi Arabia. Local reports suggest that the prevalence of asthma is increasing by time [1-3]. Many asthma patients continue to be underdiagnosed, undertreated, and at risk of acute exacerbations resulting in missed work or school, increased Correspondence to: Dr. Mana M. Al-Shahrani, The Department of Family Medicine, King Faisal Medical City, Southern Region, Saudi Arabia use of expensive acute healthcare services, and reduced quality of life (QOL). Asthma affects the life of patients in several issues, including, physiological and psychological aspects, that lead to disturbed QOL [4-6]. Disorders related to bronchial asthma usually reduce physical activity of patients, hamper job performance, interrupt sleep at night, force patients to get frequent medical appointments and undergo active pharmacotherapy, and sometimes are even a reason for hospitalization. The above restrictions can negatively affect QOL and impair sexual functioning [7,8]. Hence, control of asthma is a very important step to avoid the disturbance of patients' QOL. Nevertheless, the issue of the QOL of patients with bronchial asthma is very often overlooked in clinical practice. Therefore, this study aimed to identify the impact of bronchial asthma on QOL of asthmatic patients with bronchial asthma. Patients and Methods This research followed a cross sectional study design. It was conducted during the period from January to June 2016 at the chronic it included 380 bronchial asthma patients attending the Chronic Diseases Clinic at Ahad Rufaidah Family Medicine Center and the Asthma Clinic at the Armed Forces Hospital, Khamis Mushait City, Saudi Arabia. The Arabic version of the Quality of Life Index (QLI), Pulmonary Version III was used to assess QOL of asthmatic It is a validated questionnaire with high internal consistency reliability 663

2 664 Effect of Bronchial Asthma on QOL among Patients Attending Family Medicine Clinics coefficient. Patients were asked to rate their current QOL response on a scale from 1 (very dissatisfied) to 6 (very satisfied) in part I, and from 1 (very unimportant) to 6 (very important) in Part II. Scores were calculated by weighing the percentage of each satisfaction response with its paired importance response. This reflects individual s and satisfaction as an accurate estimate of QOL. The highest scores result from a combination of high satisfaction/high importance responses and the lowest scores for dissatisfaction/unimportance. The same steps are followed for subscale calculations. Those with scores less than 70 are considered a low QOL [9-11]. The ethical approval for conducting this study was obtained from the Armed Forces Hospital Ethical Committee. Moreover, a verbal informed consent was taken from participant asthmatic patients prior to interview. Collected data collected were computer-analyzed using the SPSS for IBM (Version 22 statistical packages. Quality of life parameters were described by means and Standard Deviations (SD) for different age groups after confirmation of parametric distribution, student's t-test and one way ANOVA were used for analysis. s were considered as statistically significant if less than Results Table (1) shows the characteristics of the studied group, as gender (males 45.3% and females 54.7%), age groups (42.1% were less than 30 years old, while 9.5% were above 60 years old), residence (19.2% rural and 80.8% urban), marital status (46.8% were married), duration of disease (<1 year among 40% while >10 years among 9.2%) and frequency of asthmatic attacks (<4/month among 60.8%). Table (2) describes the scores for (mean ± SD) among studied group. Most mean QOOL scores were low, especially role limitation due or due (28.8±22.4 and 32.2 ±22.1, respectively). Table (3) shows that female asthmatic patients had a significantly lower mean QOL score regarding the social functioning domain (p=0.03) than male However, there were no significant differences regarding mean scores for all other according to patients' gender. Table (4) shows no significant differences regarding asthmatic patients' QOL scores (mean ± SD) according to their age groups. Table (5) shows that patients living in rural areas had significantly higher mean QOL scores regarding their energy, pain and general health (p<0.01 for all) than those living in urban areas. However, there were no significant differences regarding mean scores for all other according to patients' residence. Table (6) shows that unmarried patients had significantly lower mean QOL scores regarding their emotional wellbeing and general health ( p< 0.01 for all) than those who were married. However, there were no significant differences regarding mean scores for all other according to patients' residence. Table (7) shows no significant differences regarding asthmatic patients' QOL scores (mean ± SD) according to their duration of disease. Table (8) shows patients with more frequency of asthmatic attacks (>4/month) had significantly lower mean QOL scores regarding their physical functioning and general health (p<0.0 1 and p<0.05, respectively) than those who had lower frequency of asthmatic attacks (<4/month). However, there were no significant differences regarding mean scores for all other according to their frequency of asthmatic attacks. Table (1): Characteristics of asthmatic Characteristics No. % Gender: Male Female Age group (in years): < > Residence: Rural Urban Marital status: Married Not married Duration of disease: <1 year years years > 10 years Frequency of asthmatic attacks: <4/month /month

3 Mana M. Al-Shahrani, et al. 665 Table (2): ' scores (mean ± SD) for asthmatic Mean SD Physical functioning Role limitations due Role limitations due Energy Emotional wellbeing Social functioning Pain General health Table (3): Scores for (mean ± SD) according to asthmatic patients' gender. Physical functioning. Role limitations due to physical health. Role limitations due to emotional problems. Energy. Emotional wellbeing. Social functioning. Pain. General health. Males 62.7± ± ± ± ± ± ± ± 10.2 Females 62.0± ± ± ± ± ± ± ± Table (4): Scores for (mean ± SD) according to asthmatic patients' age groups. <30 years years years years >60 years Physical functioning 64.2± ± ± ± ± Role limitations due 27.1± ± ± ± ± Role limitations due 29.0± ± ± ± ± Energy 51.4± ± ± ± ± Emotional wellbeing 60.6± ± ± ± ± Social functioning 55.2± ± ± ± ± Pain 70.8± ± ± ± ± General health 51.9± ± ± ± ± Table (5): Scores for (mean ± SD) according to asthmatic patients' residence. Table (6): Scores for (mean ± SD) according to asthmatic patients' marital status. Urban Rural Married Not married Physical functioning 61.2± ± Physical functioning 64.5± ± Role limitations due 33.6± ± Role limitations due 31.3± ± Role limitations due 35.6± ± Role limitations due 36.1± ± Energy 58.3± ± 13.2 <0.01 Energy 55.7± ± Emotional wellbeing 63.6± ± Emotional wellbeing 64.1± ± 11.4 <0.01 Social functioning 58.7± ± Social functioning 59.1± ± Pain 80.5± ±22.1 <0.01 Pain 74.3± ± General health 57.2± ±9.6 <0.01 General health 55.0± ±7.5 <0.01 Table (7): Scores for (mean ± SD) according to patients' duration of disease. <1 year 1-5 years 6-10 years >10 years Physical functioning 66.0± ± ± ± Role limitations due 27.5± ± ± ± Role limitations due 31.1± ± ± ± Energy 52.0± ± ± ± Emotional wellbeing 61.9± ± ± ± Social functioning 57.5± ± ± ± Pain 72.5± ± ± ± General health 52.8± ± ± ±

4 666 Effect of Bronchial Asthma on QOL among Patients Attending Family Medicine Clinics Table (8): Scores for (mean ± SD) according to frequency of asthmatic attacks. <4/month 4/month p - Physical functioning 64.9± ±21.1 <0.01 Role limitations due 31.9± ± Role limitations due 33.3± ± Energy 54.3± ± Emotional wellbeing 62.6± ± Social functioning 58.5± ± Pain 71.5± ± General health 52.9± ±9.3 <0.05 Discussion This study revealed that asthmatic patients' QOL scores (mean ± SD) for different domains were low (mostly less than 70), especially role limitation due or due to emotional problems. Mean QOL scores did not differ significantly according to patients' age groups, but QOL scores were significantly lower among female These low QOL scores indicate the impact of bronchial asthma and restricted activities and the way of living. This finding is in agreement with that of Nalina and Chandra [12], who stated that bronchial asthma is one of the major causes of morbidity that has a major impact on quality of life of the They added that there was greater impairment in quality of life among female patients, indicating that sex is a determinant for QOL in asthma However, Filanowicz et al., [13] reported no significant relationship between gender or age and quality of life among asthmatic This study also showed that patients living in rural areas had significantly lower mean QOL scores regarding their energy, pain and general health than those living in urban areas. This finding may be explained by more presence of environmental respiratory precipitating factors for allergy and bronchial asthma in rural areas (e.g., pollen grains) than urban areas [14]. Nevertheless, Szynkiewicz et al., [15], in Poland, reported that place of residence does not influence quality of life among patients with asthma. Difference in research results regarding impact of residence on QOL of bronchial asthma patients difference may be due differences in socioeconomic and climate factors in Poland compared with Saudi Arabia. The present study found that unmarried patients had significantly lower QOL scores, especially regarding their emotional wellbeing and general health than those who were married. This finding may be explained by that married patients have better chances to receive better care from their spouses than those who are not married. Moreover, this study showed no significant regarding asthmatic patients' QOL scores according to their duration of disease. However, patients with more frequency of asthmatic attacks had significantly lower QOL regarding their physical functioning and general health than those who had lower frequency of asthmatic attacks. Similarly, Skrzypulec et al., [16], who reported no significant impact for disease duration on bronchial asthma patients' QOL. Pereira et al., [17] reported that the degree of asthma control, as expressed by frequency of asthmatic attacks, appears to have a significant impact on health-related QOL. In conclusion, QOL of bronchial asthma patients is low. QOL is more affected among females, nonmarried patients living in rural areas, and those with more frequency of asthmatic attacks. Therefore, physicians should routinely assess QOL among their asthmatic Limitations in patients' quality of life, indicate that asthma is not well controlled. References 1- AL-GHAMDI B.R., MAHFOUZ A.A., ABDELMONEIM I., KHAN M.Y. and DAFFALLAH A.A.: Altitude and bronchial asthma in south-western Saudi Arabia. East Mediterr. Health J., 14 (1): 17-23, RABE K.F., ADACHI M., LAI C.K., SORIANO J.B., VERMEIRE P.A., WEISS K.B. and WEISS S.T.: Worldwide severity and control of asthma in children and adults: The global asthma insights and reality surveys. Journal of Allergy and Clinical Immunology, 114 (1): 40-7, ABUDAHISH A. and BELLA H.: Primary care physicians perceptions and practices on asthma care in Aseer region, Saudi Arabia. Saudi Medical Journal, 27 (3): 333-7, AL-ZAHRANI J.M., AHMAD A., AL-HARBI A., KHAN A.M., AL-BADER B., BAHAROON S., et al.: Factors associated with poor asthma control in the outpatient clinic setting. Ann. Thorac. Med., 10: 100-4, WILSON S.R., RAND C.S., CABANA M.D., FOGGS M.B., HALTERMAN J.S., OLSON L., VOLLMER W.M., WRIGHT R.J. and TAGGART V.: Asthma Outcomes: Quality of Life. J. Allergy Clin. Immunol., 129 (3): S88-123, JONES P.W.: Measurement of health-related quality of life in asthma and chronic obstructive airways disease. In Quality of Life Assessment: Key Issues in the 1990s 1993 (pp ). Springer Netherlands.

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