Comparison between the health-related quality of life of children/adolescents with asthma and that of their caregivers: a systematic review and meta-analysis

Roncada, Cristian; Medeiros, Tássia Machado; Strassburger, Márcio Júnior; Strassburger, Simone Zeni; Pitrez, Paulo Márcio

doi:10.36416/1806-3756/e20190095

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Brasil

Jornal Brasileiro de Pneumologia

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Brasil

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Sumário

META-ANALYSIS • J. bras. pneumol. 46 (03) • 2020 • https://doi.org/10.36416/1806-3756/e20190095 copy

Comparison between the health-related quality of life of children/adolescents with asthma and that of their caregivers: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the health-related quality of life (HRQoL) of children/adolescents with asthma and that of their caregivers, comparing the two.

Methods:

This was a systematic review and meta-analysis based on the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, with a strategy of searching five health-related databases (MEDLINE/PubMed, EMBASE, ScienceDirect, SciELO, and LILACS). We included studies that evaluated the HRQoL of children/adolescents with asthma and that of their caregivers with the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver’s Quality of Life Questionnaire, respectively, using the total scores and the scores on the domains activity limitation, symptoms (children/adolescents only), and emotional function.

Results:

We identified 291 articles, and we evaluated 133 of those. A total of 33 articles, collectively including 4,101 subjects, were included in the meta-analysis. An analysis stratified by study design showed no differences between the HRQoL of the caregivers and that of the children/adolescents in the activity limitation domain and in the total score. However, the mean emotional function domain scores were significantly higher (better) among children/adolescents with asthma than among their caregivers in longitudinal studies-Δ = 0.82 (0.21-1.44)-and randomized clinical trials-Δ = 0.52 (0.29-0.79)-although not in cross-sectional studies-Δ = −0.20 (−0.03 to 0.43).

Conclusions:

The total HRQoL scores proved to be similar between children/adolescents with asthma and their caregivers. However, the two groups differed in their perception of their emotional function, the caregivers scoring significantly lower than the children/adolescents in that domain.

Keywords:
Asthma; Quality of life; Surveys and questionnaires

Author	Year	Country	Study design	Age of asthma patients, years	Study participants, n
Ahmed et al.¹⁶16 Ahmed PA, Ulonnam CC, Mohammed-Nafi'u R. Assessment of quality of life among children with bronchial asthma and their caregivers at the National Hospital Abuja, Nigeria. Niger J Paediatr. 2016;43(2):88-94. https://doi.org/10.4314/njp.v43i2.5 https://doi.org/10.4314/njp.v43i2.5...	2016	Nigeria	Longitudinal	7-17	43
Almomani et al.¹⁷17 Almomani BA, Mayyas RK, Ekteish FA, Ayoub AM, Ababneh MA, Alzoubi SA. The effectiveness of clinical pharmacist's intervention in improving asthma care in children and adolescents: Randomized controlled study in Jordan. Patient Educ Couns. 2017;100(4):728-735. https://doi.org/10.1016/j.pec.2016.11.002 https://doi.org/10.1016/j.pec.2016.11.00...	2017	Jordan	RCT	7-18	206
Ammari et al.¹⁸18 Ammari WG, Al-Hyari N, Obeidat N, Khater M, Sabouba A, Sanders M. Mastery of pMDI technique, asthma control and quality-of-life of children with asthma: A randomized controlled study comparing two inhaler technique training approaches. Pulm Pharmacol Ther. 2017;43:46-54. https://doi.org/10.1016/j.pupt.2017.02.002 https://doi.org/10.1016/j.pupt.2017.02.0...	2017	UK	RCT	7-17	76
Berger et al.¹⁹19 Berger WE, Leflein JG, Geller DE, Parasuraman B, Miller CJ, O'Brien CD, et al. The safety and clinical benefit of budesonide/formoterol pressurized metered-dose inhaler versus budesonide alone in children. Allergy Asthma Proc. 2010;31(1):26-39.	2010	USA	RCT	6-11	186
Burks et al.²⁰20 Burks ML, Brooks EG, Hill VL, Peters JI, Wood PR. Assessing proxy reports: agreement between children with asthma and their caregivers on quality of life [published correction appears in Ann Allergy Asthma Immunol. 2013;111(4):309]. Ann Allergy Asthma Immunol. 2013;111(1):14-19. https://doi.org/10.1016/j.anai.2013.05.008 https://doi.org/10.1016/j.anai.2013.05.0...	2013	USA	Cross-sectional	5-17	79
Bushnell et al.²¹21 Bushnell DM, Martin ML, Parasuraman B. Electronic versus paper questionnaires: a further comparison in persons with asthma. J Asthma. 2003;40(7):751-762. https://doi.org/10.1081/JAS-120023501 https://doi.org/10.1081/JAS-120023501...	2003	USA	Cross-sectional	7-17	104
Cano-Garcinuño et al.²²22 Cano-Garcinuño A, Díaz-Vázquez C, Carvajal-Urueña I, Praena-Crespo M, Gatti-Viñoly A, García-Guerra I. Group education on asthma for children and caregivers: a randomized, controlled trial addressing effects on morbidity and quality of life. J Investig Allergol Clin Immunol. 2007;17(4):216-226.	2007	Spain	RCT	9-13	245
Ducret et al.²³23 Ducret CB, Verga M, Stoky-Hess A, Verga J, Gehri M. Impact d'une école de l'asthme sur la consommation en soins et la qualité de vie des enfants âgés de 4 à 12 ans et de leurs parents. Arch Pediatr. 2013;20(11):1201-1205. https://doi.org/10.1016/j.arcped.2013.08.021 https://doi.org/10.1016/j.arcped.2013.08...	2013	Switzerland	Longitudinal	4-12	54
Erickson et al.²⁴24 Erickson SR, Munzenberger PJ, Plante MJ, Kirking DM, Hurwitz ME, Vanuya RZ. Influence of sociodemographics on the health-related quality of life of pediatric patients with asthma and their caregivers. J Asthma. 2002;39(2):107-117. https://doi.org/10.1081/JAS-120002192 https://doi.org/10.1081/JAS-120002192...	2002	USA	Cross-sectional	9-17	99
Fleming et al.²⁵25 Fleming L, Murray C, Bansal AT, Hashimoto S, Bisgaard H, Bush A, et al. The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts [published correction appears in Eur Respir J. 2017;49(6):]. Eur Respir J. 2015;46(5):1322-1333. https://doi.org/10.1183/13993003.00780-2015 https://doi.org/10.1183/13993003.00780-2...	2015	UK	Longitudinal	6-17	271
Halterman et al.²⁶26 Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, et al. A pilot study to enhance preventive asthma care among urban adolescents with asthma. J Asthma. 2011;48(5):523-530. https://doi.org/10.3109/02770903.2011.576741 https://doi.org/10.3109/02770903.2011.57...	2011	USA	Longitudinal	12-15	30
Juniper et al.²⁷27 Juniper EF, Gruffydd-Jones K, Ward S, Svensson K. Asthma Control Questionnaire in children: validation, measurement properties, interpretation. Eur Respir J. 2010;36(6):1410-1416. https://doi.org/10.1183/09031936.00117509 https://doi.org/10.1183/09031936.0011750...	2010	Canada	Cross-sectional	6-16	35
Kamps et al.²⁸28 Kamps AW, Brand PL, Kimpen JL, Maillé AR, Overgoor-van de Groes AW, van Helsdingen-Peek LC, et al. Outpatient management of childhood asthma by paediatrician or asthma nurse: randomised controlled study with one year follow up. Thorax. 2003;58(11):968-973. https://doi.org/10.1136/thorax.58.11.968 https://doi.org/10.1136/thorax.58.11.968...	2003	The Netherlands	RCT	2-16	74
Lang et al.²⁹29 Lang JE, Hossain MJ, Lima JJ. Overweight children report qualitatively distinct asthma symptoms: analysis of validated symptom measures. J Allergy Clin Immunol. 2015;135(4):886-93.e3. https://doi.org/10.1016/j.jaci.2014.08.029 https://doi.org/10.1016/j.jaci.2014.08.0...	2015	USA	Longitudinal	10-17	56
Lenney et al.³⁰30 Lenney W, McKay AJ, Tudur Smith C, Williamson PR, James M, Price D, et al. Management of Asthma in School age Children On Therapy (MASCOT): a randomised, double-blind, placebo-controlled, parallel study of efficacy and safety. Health Technol Assess. 2013;17(4):1-218. https://doi.org/10.3310/hta17040 https://doi.org/10.3310/hta17040...	2013	UK	RCT	6-14	63
Liu et al.³¹31 Liu Z, Qureshi K. Efficacy of an Asthma Self-management Education Intervention for Children (9-13 Years) with Asthma and Their Caregiver in Wuhan, China. J US-China Med Sci. 2016;13:117-128. https://doi.org/10.17265/1548-6648/2016.03.001 https://doi.org/10.17265/1548-6648/2016....	2016	China	RCT	9-13	72
Meza et al.³²32 Meza ÉD, Puentes ÓUB, Blanc JPG, García MG, Halley PD, Duque CAT. Evaluación del control del asma y la calidad de vida de los niños y sus padres o cuidadores en un programa de atención integral del asma (Programa Asmaire Infantil). Rev Medica Sanitas. 2012;15(4):36-42.	2012	Colombia	Longitudinal	2-15	168
Minard et al.³³33 Minard JP, Thomas N, Olajos-Clos J, Juniper EF, Jiang X, Jenkins B, et al. Burden Of Childhood Asthma: Relationship Between Pediatric And Caregiver Electronic Quality Of Life Questionnaires. ATS. 2011:A1435. https://doi.org/10.1164/ajrccm-conference.2011.183.1_MeetingAbstracts.A1435 https://doi.org/10.1164/ajrccm-conferenc...	2011	Canada	Cross-sectional	7-17	63
Minard et al.³⁴34 Minard JP, Thomas NJ, Olajos-Clow JG, Wasilewski NV, Jenkins B, Taite AK, et al. Assessing the burden of childhood asthma: validation of electronic versions of the Mini Pediatric and Pediatric Asthma Caregiver's Quality of Life Questionnaires. Qual Life Res. 2016;25(1):63-69. https://doi.org/10.1007/s11136-015-1055-y https://doi.org/10.1007/s11136-015-1055-...	2016	Canada	Cross-sectional	7-17	126
Moreira et al.³⁵35 Moreira A, Delgado L, Haahtela T, Fonseca J, Moreira P, Lopes C, et al. Physical training does not increase allergic inflammation in asthmatic children. Eur Respir J. 2008;32(6):1570-1575. https://doi.org/10.1183/09031936.00171707 https://doi.org/10.1183/09031936.0017170...	2008	Portugal	RCT	8-17	34
Murray et al.³⁶36 Murray CS, Foden P, Sumner H, Shepley E, Custovic A, Simpson A. Preventing Severe Asthma Exacerbations in Children. A Randomized Trial of Mite-Impermeable Bedcovers. Am J Respir Crit Care Med. 2017;196(2):150-158. https://doi.org/10.1164/rccm.201609-1966OC https://doi.org/10.1164/rccm.201609-1966...	2017	UK	RCT	3-17	284
Mussaffi et al.³⁷37 Mussaffi H, Omer R, Prais D, Mei-Zahav M, Weiss-Kasirer T, Botzer Z, et al. Computerised paediatric asthma quality of life questionnaires in routine care. Arch Dis Child. 2007;92(8):678-682. https://doi.org/10.1136/adc.2006.111971 https://doi.org/10.1136/adc.2006.111971...	2007	Israel	RCT	7-17	115
Nair et al.³⁸38 Nair S, Nair S, Sundaram KR. A prospective study to assess the quality of life in children with asthma using the pediatric asthma quality of life questionnaire. Indian J Allergy Asthma Immunol. 2014;28(1):13-18. https://doi.org/10.4103/0972-6691.134210 https://doi.org/10.4103/0972-6691.134210...	2014	India	Longitudinal	7-17	69
Ovšonková et al.³⁹39 Ovšonková A, Plavnická I, Jeseňák M. The quality of life of parents and children with asthma bronchial. Ošetřovatelství a porodní asistence. 2012;3(3):424-432.	2012	Slovakia	Cross-sectional	7-17	72
Strunk et al.⁴⁰40 Strunk RC, Bacharier LB, Phillips BR, Szefler SJ, Zeiger RS, Chinchilli VM, et al. Azithromycin or montelukast as inhaled corticosteroid-sparing agents in moderate-to-severe childhood asthma study. J Allergy Clin Immunol. 2008;122(6):1138-1144.e4. https://doi.org/10.1016/j.jaci.2008.09.028 https://doi.org/10.1016/j.jaci.2008.09.0...	2008	USA	RCT	6-17	55
Szabó et al.⁴¹41 Szabó A, Mezei G, Kovári E, Cserháti E. Depressive symptoms amongst asthmatic children's caregivers. Pediatr Allergy Immunol. 2010;21(4 Pt 2):e667-e673. https://doi.org/10.1111/j.1399-3038.2009.00896.x https://doi.org/10.1111/j.1399-3038.2009...	2010	Hungary	Cross-sectional	7-17	102
Tibosch et al.⁴²42 Tibosch M, Reidsma C, Landstra A, Hugen C, Gerrits P, Brouwer M, et al. An asthma-related quality of life instrument is unable to identify asthmatic children with major psychosocial problems. Eur J Pediatr. 2010;169(12):1495-1501. https://doi.org/10.1007/s00431-010-1250-3 https://doi.org/10.1007/s00431-010-1250-...	2010	The Netherlands	Cross-sectional	6-16	339
van Bragt et al.⁴³43 van Bragt S, van den Bemt L, Kievits R, Merkus P, van Weel C, Schermer T. PELICAN: a cluster-randomized controlled trial in Dutch general practices to assess a self-management support intervention based on individual goals for children with asthma. J Asthma. 2015;52(2):211-219. https://doi.org/10.3109/02770903.2014.952439 https://doi.org/10.3109/02770903.2014.95...	2015	The Netherlands	RCT	6-11	29
van Gent et al.⁴⁴44 van Gent R, van Essen LE, Rovers MM, Kimpen JL, van der Ent CK, de Meer G. Quality of life in children with undiagnosed and diagnosed asthma. Eur J Pediatr. 2007;166(8):843-848. https://doi.org/10.1007/s00431-006-0358-y https://doi.org/10.1007/s00431-006-0358-...	2007	The Netherlands	Cross-sectional	7-10	413
Voorend-van Bergen et al.⁴⁵45 Voorend-van Bergen S, Vaessen-Verberne AA, Landstra AM, Brackel HJ, van den Berg NJ, Caudri D, et al. Monitoring childhood asthma: web-based diaries and the asthma control test. J Allergy Clin Immunol. 2014;133(6):1599-605.e2. https://doi.org/10.1016/j.jaci.2013.10.005 https://doi.org/10.1016/j.jaci.2013.10.0...	2014	The Netherlands	RCT	4-18	197
Voorend-van Bergen et al.⁴⁶46 Voorend-van Bergen S, Vaessen-Verberne AA, Brackel HJ, Landstra AM, van den Berg NJ, Hop WC, et al. Monitoring strategies in children with asthma: a randomised controlled trial. Thorax. 2015;70(6):543-550. https://doi.org/10.1136/thoraxjnl-2014-206161 https://doi.org/10.1136/thoraxjnl-2014-2...	2015	The Netherlands	RCT	4-18	270
Williams et al.⁴⁷47 Williams J, Williams K. Asthma-specific quality of life questionnaires in children: are they useful and feasible in routine clinical practice?. Pediatr Pulmonol. 2003;35(2):114-118. https://doi.org/10.1002/ppul.10206 https://doi.org/10.1002/ppul.10206...	2003	UK	Cross-sectional	7-17	42
Yun et al.⁴⁸48 Yun TJ, Jeong HY, Hill TD, Lesnick B, Brown R, Abowd GD, et al. Using SMS to provide continuous assessment and improve health outcomes for children with asthma. Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium; 2012 Jan; Miami FL, USA. ACM; 2012. p. 621-630. https://doi.org/10.1145/2110363.2110432 https://doi.org/10.1145/2110363.2110432...	2012	USA	RCT	7-17	30

Characteristic	Result
Total sample^b	4,101 (100.0)
Children/adolescents with asthma
Male sex (n = 4,101)	2,495 (60.8)
Age, years (n = 3,660)	10.3 ± 4.0
White (n = 1,018)	699 (68.7)
Mild/moderate asthma (n = 1,149)	896 (78.0)
Pharmacological treatment (n = 2,549)
MDI	1,240 (48.7)
SABA	814 (31.9)
LABA	495 (19.4)
Controlled asthma (n = 1,063)	576 (54.2)
ACQ (n = 585)	1.0 ± 0.8
C-ACT (n = 553)	21.4 ± 2.6
ACT (n = 1,000)	20.2 ± 2.8
Rhinitis (n = 422)	157 (37.2)
Atopia (n = 441)	307 (69.5)
Lung function
FEV₁, % predicted (n = 2,303)	92.0 ± 14.6
FVC, % predicted (n = 1,427)	97.3 ± 13.8
FEV₁/FVC (n = 495)	0.8 ± 0.1
FeNO (n = 858)	31.4 ± 16.9
PAQLQ (children/adolescents)
Activity limitation (n = 2,796)	5.1 ± 1.1
Symptoms (n = 2,618)	5.2 ± 1.1
Emotional function (n = 2,796)	5.6 ± 1.0
Total score (n = 4,101)	5.5 ± 1.0
PACQLQ (caregivers)
Activity limitation (n = 2,491)	5.3 ± 1.2
Emotional function (n = 2,607)	5.1 ± 1.1
Total score (n = 4,101)	5.4 ± 1.0

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[1] Correspondence to: Márcio Junior Strassburger. Rua do Comércio, 3000, Bairro Universitário, CEP 98700-000, Ijuí, RS, Brasil. Tel.: 55 55 3332-0461. E-mail: marcio.s@unijui.edu.br