YETİŞKİN ASTIM HASTALARINDA YAŞAM KALİTESİ VE YAŞAM KALİTESİNİ ETKİLEYEN FAKTÖRLERİN TANILANMASI

Öz

Amaç: Bu çalışmanın amacı yetişkin astım hastalarının yaşam kalitesini sağlıklı kontrol grup ile karşılaştırarak tanımlamak ve hastaların yaşam kalitesi ile demografik, astımla ilgili değişkenler, psikolojik durum arasındaki ilişkiyi değerlendirmektir. Gereç ve yöntem: Göğüs hastalıkları anabilim dalı polikliniğinde bir yıldır takipli olan hastalardan 1 Nisan-30 Mayıs 2005 tarihlerinde başvuran, okur yazar olan, psikotik belirtileri veya mental retardasyon saptanmayan, çalışmaya katılmayı kabul eden hastalar çalışmaya alındı (n=176). Hastalara yarı yapılandırılmış görüşme formu, psikiyatrik tanılama için standart tanı formu olan KISA(Kısa Sağlık Anketi/Brief Patient Health Questionnaire-Brief PHQ), sağlık alanında yaşam kalitesini değerlendirmek için SF-36 uygulandı. Kontrol grup, astımlı grupla sosyodemografik özellikleri eşleştirilmiş genel populasyondan seçilmiş 100 sağlıklı yetişkin ile oluşturulmuştur. Bulgular: Hastaların yaş ortalaması 46,27 ± 11,46 yıl idi, %77,3’ü kadındı. Hastalık süresi ortalama 13,03 ± 8,84 yıl idi. GINA (The Global Initiative for Asthma)’ya göre hastalık evresi %47,2’si orta persistan düzeydeydi. Hastaların ortalama FEV1 yüzde değeri 86,62 ± 20,16 L idi. KISA’ya göre psikiyatrik tanı oranı %29 bulundu. Astım hastalarının SF-36 yaşam kalitesinin tüm alt boyutlarında puanları kontrol grubundan düşük bulundu (p < 0,05). Psikiyatrik bir tanının varlığı hem fiziksel, hem mental sağlık boyutunda yaşam kalitesini düşürdüğü saptandı (p < 0,001). Sonuç: Hastalıkla ilgili fiziksel parametreler yaşam kalitesinin yalnızca fiziksel boyutunu etkilediği saptanırken, psikiyatrik tanı konulan hastalarda ise tüm alt boyutlarda yaşam kalitesinin anlamlı düzeyde etkilendiği bulundu.

Anahtar Kelimeler

• Astım, yaşam kalitesi, SF-36, KISA

Kaynakça

1. Abramson MJ, Bailey MJ, Couper FJ, Driver JS, Drummer OH, Forbes AB. Are asthma medications and management related to deaths from asthma? Am J Respir Crit Care Med 2001;163:12- 18.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric As- sociation, Washington, DC, 1994.
3. Apter AJ, Reisine ST, Affleck G, Barrows E, ZuWallack RL. The influence of demographic and socioeconomic factors on he- alth-related quality of life in asthma. J Allergy Clin Immunol
4. Bonala SB, Pina D, Silverman BA, Amara S, Bassett CW, Schneider AT. Asthma severity, psychiatric morbidity, and qu- ality of life: correlation with inhaled corticosteroid dose. J Asth- ma 2003;40:691–699.
5. Bousquet J, Knani J, Dhivert H, Richard A, Chicoye A, Ware JE & Michel FB. Quality of life in asthma, I:Internal consistency and validity of the SF-36 questionnaire. Am J Respir Crit Care Med 1994;149:371–375.
6. CDC, National Center for Health Statistics. Asthma prevalence, health care use and mortality, 2000–2001. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asth- ma/asthma.htm.
7. Corapcıoglu A, Uzuner Ozer G. Adaptation of revised Brief PHQ (Brief-PHQ-r) for diagnosis of depression, panic disorder and somatoform disorder in primary healthcare settings. Int J Psychiatr Clin Prac 2004;8:11-18.
8. Ekici A, Ekici M, Kara T, Keles H, Kocyigit P. Negative mood and quality of life in patients with asthma. Quality of Life Rese- arch 2006;15:49–56.

9. Erickson SR, Christian RD, Kirking DM, Halman LJ. Relations- hip between patient and disease characteristics, and health-rela- ted quality of life in adults with asthma. Respiratory Medicine 2002;96:450-460.
10. Feldman JM, Lehrer PM, Borson S, Hallerstrand TS, Siddique MI. Health care use and quality of life among patient with asth- ma and panic disorder. J Asthma 2005;42:179–184.
11. Gaga M, Papageorgiou N, Zervas E, Gioulekas D, Konstatopo- ulos S. Control of asthma under specialist care: is it achieved? Chest 2005;128:78-84.
12. Global Initiative for Asthma. Global strategy for asthma mana- gement and prevention NHLBI/ WHO workshop report. Nati- onal Heart, Lung and Blood Institute Publication Number 02- 3659, 1995; pp139-168.
13. Goldney RD, Ruffin R, Fisher LJ, Wilson DH. Asthma symp- toms associated with depression and lower quality of life: a po- pulation survey. Med J Aust 2003;178:437–441.
14. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118:622-629.
15. Hazell M, Frank T, Frank P. Health related quality of life in indi- viduals with asthma related symptoms. Respiratory Medicine 2003;97:1211–1218.
16. Henkel V, Mergl R, Kohnen R, Maier W, Moller HJ, Hegerl U. Identifying depression in primary care: a comparison of different methods in a prospective cohort study. British Medical Journal 2003;326:200-201.
17. Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Po- liquin S, Berger C, Joseph L, Brown JP, Murray TM, Adachi JD, Hanley DA, Papadimitropoulos E, The Canadian Mulitcentre Osteoporosis Study Research Group. Canadian normative data for the SF-36 Health Survey. Can Med Assoc J 2000;163:265–271.
18. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring qu- ality of life in asthma. Am Rev Respir Dis 1993;147:832-838.
19. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hil- ler TK. Evaluation of impairment of health related quality of li- fe in asthma: Development of a questionnaire for use in clinical trials. Thorax 1992;47:76–83.
20. Juniper EF. Assessing health-related quality of life in asthma. Can Respir J 1997;3:17–20.
21. Kalyoncu AF, Karakoca Y, Demir AU, Alpar R, Shehu V, Coplu L, Sahin AA, Baris YI. Prevalence of asthma and allergic dise- ases in Turkish university students in Ankara. Allergol Immuno- pathol 1996;24:152-157.
22. Kalyoncu F. Kalyoncu F. İç, Doğu ve Güneydoğu Anadolu Böl- gesi'nde astım ve diğer allerjik hastalıkların epidemiyolojisi. Alerji ve İmmünoloji Bülteni 1998;10; 23-26.
23. Klinnert MD. Evaluating the effects of stress on asthma: A para- doxical challenge. Eur Respir J 2003;22:574–575.
24. Kocyiğit H, Aydemir O, Fişek G, Ölmez N, Memiş A. Kısa form-36'nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve Tedavi Dergisi 1999; 12: 102-6.
25. Küçükusta AR. Epidemiyoloji. In: Gemicioğlu B; ed. Tanımdan tedaviye astım. İstanbul: Turgut Yayıncılık, 1. basım, 2005; pp 5- 26.
26. Lavoie KL, Cartier A, Labrecque M, Bacon SL, Lemiere C, Ma- lo JL, Lacoste G, Barone S, Verrier P, Ditto B. Are psychiatric di- sorders associated with worse asthma control and quality of life in asthma patients? Respir Med 2005;99:1249–1257.
27. Lavoie KL, Bacon SL, Barone S, Cartier A, Ditto B, Labrecque M. What is worse for asthma control and quality of life: depres- sive disorders, anxiety disorders, or both? Chest 2006;130(4):1039-47.
28. Lipton MW, McConnachie A, McSharry C, Hart CL, Smith GD, Gillis CR, Watt GCM. Intergenerational twenty-year trends in the prevalence of asthma and hay fever in adults: the Midspan family study survey of parents and offspring. BMJ 2000;321:88–92.
29. Löwe B, Graefe K, Kroenke K, Zipfel S, Quenter A, Wild B, Fi- ehn C, Herzog W. Predictors of psychiatric comorbidity in me- dical outpatients. Psychosomatic Medicine 2003;65:764-770.
30. Mancuso CA, Peterson MG, Charlson ME. Effects of depressi- ve symptoms on health-related quality of life in asthma patients. Gen Intern Med J 2000;15:301–310.
31. Manocchia M, Keller S, Ware JE. Sleep problems, health-related quality of life, work functioning and health care utilization among the chronically ill. Qual Life Res 2001;10:331-345.
32. Moy ML, Israel E, Weiss ST, Juniper EF, Dube L, Drazen JM, NHBLI. Asthma Clinical Research Network. Clinical predictors of health-related quality of life depend on asthma severity. Am J Respir Crit Care Med 2001;163:924– 929.
33. Oğuztürk O, Ekici A, Kara M, Ekici M, Arslan M, Iteginl, A, Ka- ra T, Kurtipek E. Psychological status and quality of life in el- derly patients with asthma. Psychosomatics 2005;46:41-46.
34. Osborne ML, Vollmer WM, Linton KLP, Buist AS. Characteris- tics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med 1998;157:123–128.
35. Ozkan M, Kocaman N, Ozkan S, Erden S, Demirel S, Dilmener M. Mood, panic and somatoform disorders in general Turkish outpatient clinic. Primary Care and Community Psychiatry 2006;11:1-5.
36. Plaza V, Serra-Batlles J, Ferrer M, Morejon E. Quality of life and economic features in elderly asthmatics. Respiration
37. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical mana- gement of asthma in 1999: The Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J 2001;18:248.
38. Schmier JK, Chan KS, Leidy NK. The impact of asthma on he- alth related quality of life. J. Asthma 1988;35:585-597.
39. Sekerel BE, Gemicioglu B. Soriano JB. Asthma insights and re- ality in Turkey (AIRET) study. Respir Med 2006; 100:1850-4.
40. Spitzer RL, Kroenke K,Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;10, 282:1737-1744.
41. Spitzer RL, Williams JB, Kroenke K, Kroenke K, Linzer M, deGruy FV, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care The PRIME-MD 1000 Study. JAMA 1994;272:1749-1756.
42. Strine TW, Ford ES, Balluz L, Chapman DP, Mokdad AH. Risk behaviors and health-related quality of life among adults with asthma: the role of mental health status. Chest 2004;126:1849–1854.
43. Testa MA, Simonson DC. Assessment of quality-of-life outco- mes. N Engl J Med 1996;334:835-840.
44. Tovt-Korshynska MI, Dew MA, Chopey IV, Spivak MY, Lem- ko IS. Gender differences in psychological distress in adults with asthma. J Psychosomatic Res 2001;51:629–637.
45. Ware JE, Snow KK, Kosinkio M, Gandek B. SF-36 Health Sur- vey Manual and Interpretation Guide. The Health Institute; New England Medical Center, Boston, NY, 1993.
46. Weiss KB, Gergen PS, Hodgson TA. An economic valuation of asthma in the United States. N Eng J Med 1992; 326: 862-66.
47. Weiss KB, Buist SA, Sullivan SD. Asthma’s Impact on Society. Marcal Dekker, New York, 2000.
48. Woolcock AJ. Worldwide differences in asthma prevalence and mortality. Chest 1990;90:405-455.
49. World Health Organization: Bronchial asthma. http://www.who.int/mediacentre/factsheets/fs206/en/print.html (revised January 2000).
50. Young SY, Gunzenhauser JD, Malone KE, McTiernan A. Body mass index and asthma in the military population of the north- western United States. Arch Intern Med 2001;161:1605-1611.