Astımda semptom kontrolü ve yaşam kalitesi ilişkisi

Öz

Amaç: Astımda ana hedef, semptom kontrolünün sağlanmasıdır. Bu çalışmada astımlı hastalarda semptom kontrolü ile “yaşam kalitesi” ilişkisi incelenmiş ayrıca ek kronik hastalık varlığı ve eğitimin etkisi araştırılmıştır.

Yöntemler: Denizli Devlet Hastanesinde Göğüs Hastalıkları Kliniğinde takip edilen 125 astımlı hasta çalışmaya alınmıştır. Hastaların demografik verileri, solunum fonksiyon testi, yaşam kalitesi anketi (SF-36) ve Astım Kontrol Testi (AKT) sonuçları kaydedildi. Hastaların tedaviden bir ay sonra ‘AKT’ ve solunum fonksiyon testleri tekrarlandı. Tedavi öncesi-sonrası değişimler istatistiksel olarak analiz edildi.

Bulgular: Çalışmaya alınan astımlı hastaların yaş ortalaması 46,8 yıl olup, %77,6’sı kadın idi. Astımlı hastaların %12,8’i sigara içiciliği, %34,4’ünde ek kronik hastalık saptandı. Astımlıların ilk AKT puanı 18,4±5,3 idi ve %13,6’sında “tam kontrol” sağlanmıştı. Yaşam kalitesi anketine göre sosyal fonksiyon puanı 67,9, mental sağlık puanı 67,7, genel sağlık puanı 62,7 olarak bulundu. SF-36 ve AKT puanları arasında anlamlı düzeyde pozitif korelasyon saptandı. Ek kronik hastalığı olanlarda (anksiyete/depresyon, hipertansiyon) yaşam kalitesi puanı ve solunum fonksiyonları daha düşük saptandı. Tedavi ve eğitimlerden bir ay sonra yapılan ikinci AKT’de 5,3 puanlık artış gözlendi (23,7±2,4) ve tam kontrol oranı %59,8’e yükseldi (p=0.001).

Sonuç: AKT puanı ile yaşam kalitesi puanı arasında yakın ilişki saptandı. Semptom kontrolündeki düzelme, yapılan tedavi ve eğitimin etkili olduğunu göstermektedir. Ek kronik hastalık varlığı astım kontrolünü, yaşam kalitesini olumsuz etkilemektedir.

Anahtar kelimeler: Yaşam kalitesi, astım, semptom kontrolü, eğitim

Anahtar Kelimeler

• Yaşam kalitesi, astım, semptom kontrolü, eğitim

-

Öz

Objective: The aim of the asthma treatment is to have full symptom control. In this study, Interaction between life quality and symptom control on asthma patients were investigated. Also patient training and the other factors on asthma control are researched.Methods: Asthma patients (125) who were followed Chest Clinics of Denizli State hospital were included to the study. The questionnaire related with socio-demographic characteristics, Asthma Control Test (ACT) and life quality questionnaire (LQQ-SF36) were applied to the patients. Pulmonary function tests (PFT) were measured. Approximately one month later; ACT and PFT were repeated and pre and post treatment changes were statistically analyzed.Results: The mean age of the patients was 46.8 years and 77.6% of them were females. 12.8 % of the patients were smoker, and 34.4 % of them had at least one chronic disease/disorder. The initial ACT point was 18.4±5.3 and 13.6% of the patients had “complete symptom-control”. According to the LQQ; social function point was found as 67.9, mental health point as 67.7, and overall health point as 62.7. Significant positive correlations were found between life quality and ACT. Positive changes in the second ACT were determined. It was found as 23.7±2.4 and the increasing of ACT point was 5.3. The rate of the patients with “complete control” was 59.8%In addition, LQQ point and some PFT parameters was found significantly lower in patients with additional diseases (anxiety/depression, diabetes etc.).Conclusion: Significantly positive correlations were found between life quality and ACT. Our findings clearly show that the trainings of patients are effective in asthma control. It was seen that the presence of co-morbidity has a negative effect on asthma control and psychological status

Anahtar Kelimeler

• Life quality, symptom, asthma, training

Kaynakça

1. GINA 2014 (Revision). Global Strategy for Asthma Management and Prevention.2014:11 http://www.ginasthma.org/local/uploads/files/GINA_Pocket_2015.pdf
2. Abadoğlu Ö. Astım kontrolünün değerlendirme anketleri.
3. Asthma Allergy Immunol 2008;6:99-104.
4. Williams SA, Wagner S, Kannan H, Bolge SC. The association between asthma control and health care utilization, work productivity loss and health-related quality of life. J Occup Environ Med 2009;51:780-785.
5. Abadoğlu Ö. Astım kontrol testi: Etkileyen faktörler ve vizüel analog skalası ile karşılaştırma. Asthma Allergy Immunol 2008;6:17-21.
6. Lavoie KL, Bacon SL, Barone S, et al. What is worse for
7. asthma control and quality of life depressive disorders, anxiety disorders, or both? Chest 2006;130:1039-1047.
8. Smith A, Krisnan JA, Bilderback A, et al. Depressive symptoms and adherence to asthma therapy after hospital discharge. Chest 2006;130:1034-1038.

9. Oh EG. The relationship between disease control, Symptom
10. distress, functioning, and quality of life in adults with asthma. J Asthma 2008;45:882-886.
11. Fidan D, Ünal B, Demiral Y. Sağlığa ilişkin yaşam kalitesi kavramı ve ölçüm yöntemleri. Sağlık ve Toplum
12. ;13:25-28.
13. Chipps BE, Spahn JD. What are the determinantes of asthma
14. control? J Asthma 2006;113:59-65.
15. Schatz M, Sorkness CA, Li JT, et al. Asthma Control Test:
16. Reliability, validity, and responsiveness in patients not previously fallowed by asthma specialists. J Allergy Clin Immunol 2006;117:549-556.
17. Uysal MA. Astım Kontrol Testinin Türkçe Versiyonun Geçerlilik ve Güvenilirliği. 15. Türk Toraks Derneği Yıllık
18. Kongresi. Kongre Kitabı 2012:23.
19. Nathan RA, Sorkness CA, Kosinski M, et al. Development
20. of the asthma control test: A survey for assessing asthma
21. control. J Allergy Clin Immunol 2004;113:59-65.
22. Bayram H, Kılınc O. Hasta Hekim İşbirliği, Hasta Eğitimi.
23. Tur Toraks Der 2014;15:28-31.
24. Bozbaş ŞS, Özyürek BA, Ulubay G. Astımda hastalık kontrolü ile demografik özellikler, yaşam kalitesi ve emosyonel durumun ilişkisi. Tur Toraks Der 2011;12:139-144.
25. Guilbert TW, Garris C, Jhingran P, et al. That Is Not Well-
26. Controlled Is Assocıated with Increased Healthcare Utilization and Decraesed Quality of Life. J Asthma 2011;48:126-132.
27. Ozoh OB, Okubadejo NU, Chukwu CC, et al. The ACT
28. and The ATAQ are useful Surrogates for Asthma Control
29. in Resource-Poor Countries with Inadequate Spirometric
30. Facilities. J Asthma 2012;49:1086-1091.
31. Alpaydın AG, Bora M, Yorgancıoğlu A, et al. Asthma Control Test and Quality of Life Questionnaire Association in
32. Adults. Iran J Allergy Asthma Immunol 2012;11:301-307.
33. Roxo JP, Ponte EV, Ramos DC, et al. Portuguese-language
34. version of the asthma control test : validation for use in Brazil.
35. J Bra Pneumol 2010;36:1806-1813.
36. Bousquet PJ, Combescure C, Neukirch F, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy 2007;62:367-372.
37. Terzano C, Cremonesi G, Girbino G, et al. 1-year prospective real life monitoring of asthma control and quality of
38. life in Italy. Respir Res 2012;13:211-217.
39. Marco FD, Verga M, Santus P, et al. Close correlation between anxiety, depression, and asthma control. Respir Med
40. ;104:22-28.
41. Laforest L, Ganse EV, Devouassoux G, et al. Influence of
42. patients characteristics and disease management on asthma
43. control. J Allergy Clin Immunol 2006;117:1404-1410.
44. Sanderg S, Paton JY, Ahola S, et al. The role of acute
45. and chronic stress in asthma attacks in children. Lancet
46. ;356:982-987.
47. Baiardini I, Braido F, Giardini A, et al. Adherence to treatment: assesment of an unmet need in asthma. J Investig Allergol Clin Immunol 2006;16:218-223.
48. Cluley S, Cochrane GM. Psychological disorder in asthma
49. is associated with poor control and poor adherence to inhaled steroids. Respir Med 2001;95:37-39.
50. Trzcinska H, Zwierzchowska B, Kozlowski B, et al. Analysis of the role of selected demographic and psychological variables (anxiety and depression) as risk factors of inadequate control of bronchial asthma. Ann Agric Environ Med 2013;20:504-508.
51. Pietras T, Panek M, Witusik A, et al. Analysis of the correlation between level of anxiety, intensity of depression
52. and bronchial asthma control. Post Dermatol Alergol
53. ;28:15–22.
54. Simmons DA, Broderick PA. Cytokines, stressors, and
55. clinical depression: augmented adaptation responses underlie depression pathogenesis. Prog Neuropsychopharmacol Biol Psychiatry 2005;29:793-807.
56. Schiepers OJ, Wichers MC, Maes M. Cytokines and major
57. depression. Prog Neuropsychopharmacol Biol Psychiatry
58. ;29:201-217.
59. Lehrer PM. Emotionally triggered asthma: a review of research literature and some hypotheses for self-regulation
60. therapies. Appl Psychophysiol Biofeedback 1998;23:13-41.
61. Hymie A, Zul M, Michael OP, et al. Cytokines as a precipi
62. tant of depressive illness: animal and human studies. Curr
63. Pharm Des 2005;11:963-972.