Abstract
Objective
To estimate the extent to which symptom status, physical activity, beliefs about medications, self-efficacy, emotional status, and healthcare utilization predict perceived asthma control over a period of 16 months among a primary care population.
Methods
The current study is a secondary analysis of data from a longitudinal study that examined health outcomes of asthma among participants recruited from primary care clinics. Path analysis, based on the Wilson and Cleary and International Classification of Functioning, Disability and Health frameworks, was used to estimate the predictors of perceived asthma control.
Results
The path analysis identified initial perceived asthma control asthma (β = 0.43, p < 0.0001), symptoms (β = 0.35, p < 0.0001), physical activity (β = 0.27, p < 0.0001), and self-efficacy (β = 0.29, p < 0.0001) as significant predictors of perceived asthma control (total effects, i.e., direct and indirect), while emotional status (β = 0.08, p = 0.03) was a significant indirect predictor through physical activity. The model explained 24 % of the variance of perceived asthma control. Overall, the model fits the data well (χ 2 = 6.65, df = 6, p value = 0.35, root-mean-square error of approximation = 0.02, Comparative Fit Index = 0.999, and weighted root-mean-square residual = 0.27).
Conclusion
Initial perceived asthma control, current symptoms status, physical activity, and self-efficacy can be used to identify individuals likely to have good perceived asthma control in the future. Emotional status also has an impact on perceived asthma control mediated through physical activity and should be considered when planning patient management. Identifying these predictors is important to help the care team tailor interventions that will allow individuals to optimally manage their asthma, to prevent exacerbations, to prevent other respiratory-related chronic disease, and to maximize quality of life.
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References
Hillegass, E. A., & Sadowsky, H. S. (2001). Pathophysiology. In A. Allen (Ed.), Essential of cardiopulmonary physical therapy (pp. 266–267). Pennsylvania: Elviser.
Mannino, D. M., et al. (2002). Surveillance for asthma–United States, 1980–1999. MMWR Surveillance Summaries, 51(1), 1–13.
The American Academy of Allergy Asthma & Immunology, Pediatric Asthma (2000). Promoting best practice—guide for managing asthma in children.
Janson, S., & Weiss, K. (2004). A national survey of asthma knowledge and practices among specialists and primary care physicians. Journal of Asthma, 41(3), 343–348.
Badiola, C., et al. (2009). Women, patients with severe asthma, and patients attended by primary care physicians, are at higher risk of suffering from poorly controlled asthma. Primary Care Respiratory Journal, 18(4), 294–299.
Mintz, M., et al. (2009). Assessment of asthma control in primary care. Current Medical Research and Opinion, 25(10), 2523–2531.
Reddel, H. K., et al. (2009). An official American Thoracic Society/European Respiratory Society statement: Asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. American Journal of Respiratory and Critical Care Medicine, 180(1), 59–99.
Juniper, E. F., et al. (1999). Development and validation of a questionnaire to measure asthma control. European Respiratory Journal, 14(4), 902–907.
Alpaydin, A. O., et al. (2012). Asthma control test and asthma quality of life questionnaire association in adults. Iranian Journal of Allergy, Asthma, and Immunology, 11(4), 301–307.
Doz, M., et al. (2013). The association between asthma control, health care costs, and quality of life in France and Spain. BMC Pulmonary Medicine, 13(1), 15.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA, 273(1), 59–65.
Lougheed, M. D., et al. (2010). Canadian thoracic society asthma management continuum–2010 Consensus Summary for children six years of age and over, and adults. Canadian Respiratory Journal, 17(1), 15–24.
Rabe, K. F., et al. (2004). Worldwide severity and control of asthma in children and adults: The global asthma insights and reality surveys. The Journal of Allergy and Clinical Immunology, 114(1), 40–47.
Gonzalez Barcala, F. J., et al. (2010). Factors associated with asthma control in primary care patients: the CHAS study. Archivos de Bronconeumologia, 46(7), 358–363.
Nguyen, K., et al. (2011). Factors associated with asthma control among adults in five New England states, 2006–2007. Journal of Asthma, 48(6), 581–588.
Stanford, R. H., et al. (2010). Predictors of uncontrolled asthma in adult and pediatric patients: analysis of the Asthma Control Characteristics and Prevalence Survey Studies (ACCESS). Journal of Asthma, 47(3), 257–262.
Laforest, L., et al. (2006). Influence of patients’ characteristics and disease management on asthma control. The Journal of Allergy and Clinical Immunology, 117(6), 1404–1410.
Peters, S. P., et al. (2007). Real-world evaluation of asthma control and treatment (REACT): Findings from a national web-based survey. The Journal of Allergy and Clinical Immunology, 119(6), 1454–1461.
Schatz, M., et al. (2007). Predictors of asthma control in a random sample of asthmatic patients. Journal of Asthma, 44(4), 341–345.
Ponte, E. V., et al. (2007). Perception of asthma control in asthma patients. Journal of Brasil Pulmonology, 33(6), 635–640.
van der Meer, V., et al. (2009). Internet-based self-management plus education compared with usual care in asthma: A randomized trial. Annals of Internal Medicine, 151(2), 110–120.
Dogra, S., Jamnik, V., & Baker, J. (2010). Self-directed exercise improves perceived measures of health in adults with partly controlled asthma. Journal of Asthma, 47(9), 972–977.
Dogra, S. et al. (2010) Exercise is associated with improved asthma control in adults. European Respiratory Journal, 37(2), 318–323.
Martin, M. A. et al. (2009). Improving asthma self-efficacy: Developing and testing a pilot community-based asthma intervention for African American adults. The Journal of Allergy and Clinical Immunology, 123(1), 153 e3–159 e3.
Mosen, D. M. et al. (2008). The relationship between obesity and asthma severity and control in adults. The Journal of Allergy and Clinical Immunology, 122(3), 507 e6–511 e6.
Rhee, H., Belyea, M. J., & Elward, K. S. (2008). Patterns of asthma control perception in adolescents: Associations with psychosocial functioning. Journal of Asthma, 45(7), 600–606.
Scherer, Y. K., & Bruce, S. (2001). Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma. Heart and Lung, 30(4), 250–257.
Stein, M. D., et al. (2005). Respiratory symptom relief related to reduction in cigarette use. Journal of General Internal Medicine, 20(10), 889–894.
Janssens, T., et al. (2009). Inaccurate perception of asthma symptoms: A cognitive–affective framework and implications for asthma treatment. Clinical Psychology Review, 29(4), 317–327.
Katz, P. P., et al. (2002). Perceived control of asthma and quality of life among adults with asthma. Annals of Allergy, Asthma & Immunology, 89(3), 251–258.
Jones, K. G., et al. (2002). Understanding patient perceptions of asthma: Results of the Asthma Control and Expectations (ACE) survey. International Journal of Clinical Practice, 56(2), 89–93.
Katz, P. P., et al. (1997). Perceived control of asthma: Development and validation of a questionnaire. American Journal of Respiratory and Critical Care Medicine, 155(2), 577–582.
Levin, K. A. (2006). Study design III: Cross-sectional studies. Evidence-Based Dentistry, 7(1), 24–25.
Kline, R. B. (2005), Introduction to path analysis. In D. A. Kenny (Ed.), Principles and practice of structural equation modeling (pp. 93–121). New York: Guilford Press.
Ahn, J. (2002). Beyond single equation regression analysis: Path analysis and multi-stage regression analysis. American Journal of Pharmaceutical Education, 66(Spring), 37–42.
WHO. International Classification of Functioning, Disability and Health (ICF). [cited 2013 09/11/2013]; http://apps.who.int/classifications/icfbrowser/.
CAD P. (2001). International classification of functioning, disability and health (ICF). World Health Organization.
Di Marco, F., et al. (2010). Close correlation between anxiety, depression, and asthma control. Respiratory Medicine, 104(1), 22–28.
Lavoie, K. L., et al. (2006). Higher BMI is associated with worse asthma control and quality of life but not asthma severity. Respiratory Medicine, 100(4), 648–657.
Lavoie, K. L., et al. (2008). Association of asthma self-efficacy to asthma control and quality of life. Annals of Behavioral Medicine, 36(1), 100–106.
Strine, T. W., et al. (2008). Impact of depression and anxiety on quality of life, health behaviors, and asthma control among adults in the United States with asthma, 2006. Journal of Asthma, 45(2), 123–133.
Di Marco, F., Santus, P., & Centanni, S. (2011). Anxiety and depression in asthma. Current Opinion in Pulmonary Medicine, 17(1), 39–44. doi:10.1097/MCP.0b013e328341005f.
Walters, P., et al. (2011). The relationship between asthma and depression in primary care patients: A historical cohort and nested case control study. PLoS ONE, 6(6), e20750.
Thomas, M., et al. (2011). Asthma and psychological dysfunction. Primary Care Respiratory Journal, 20(3), 250–256.
Lavoie, K. L., & Bacon, S. L. (2006). What is worse for asthma control and quality of life, depressive disorders, anxiety disorders, or both? Chest, 130, 1039–1047.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215.
Mancuso, C. A., Sayles, W., & Allegrante, J. P. (2010). Knowledge, attitude, and self-efficacy in asthma self-management and quality of life. Journal of Asthma, 47(8), 883–888.
Schroll, M. (2003). Physical activity in an ageing population. Scandinavian Journal of Medicine and Science in Sports, 13(1), 63–69.
Dyer, C. A., et al. (1999). Quality of life in elderly subjects with a diagnostic label of asthma from general practice registers. European Respiratory Journal, 14(1), 39–45.
Oakley, F., et al. (2002). Improvement in activities of daily living in elderly following treatment for post-bereavement depression. Acta Psychiatrica Scandinavica, 105(3), 231–234.
Lai, S. M., et al. (2002). Depressive symptoms and independence in BADL and IADL. Journal of Rehabilitation Research and Development, 39(5), 589–596.
McAuley, E., et al. (2011). Self-regulatory processes and exercise adherence in older adults: Executive function and self-efficacy effects. American Journal of Preventive Medicine, 41(3), 284–290.
Altman, B., & Bernstein, A. (2008) Disability and health in the United States, 2001–200. In National Center for Health Statistics. National Center for Health Statistics.
Ikeue, T., et al. (2010). The prevalence of cigarette smoking among asthmatic adults and association of smoking with emergency department visits. Nihon Kokyuki Gakkai Zasshi, 48(2), 99–103.
Mancuso, C. A., et al. (2001). Self-efficacy, depressive symptoms, and patients’ expectations predict outcomes in asthma. Medical Care, 39(12), 1326–1338.
Scherer, Y. K., & Bruce, S. (2001). Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma. Heart & Lung: The Journal of Acute and Critical Care, 30(4), 250–257.
Silverman, R. A., et al. (2003). Cigarette smoking among asthmatic adults presenting to 64 emergency departments*. Chest, 123(5), 1472–1479.
Tamblyn, R., et al. (2003). The medical office of the 21st century (MOXXI): Effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ, 169(6), 549–556.
Kawasumi, Y., et al. (2011). Development and validation of a predictive algorithm to identify adult asthmatics from medical services and pharmacy claims databases. Health Services Research, 46(3), 939–963.
Horne, R., & Weinman, J. (1999). Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47(6), 555–567.
Horne, R., Weinman, J., & Hankins, M. (1999) The beliefs about Medicines Questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychology & Health, 14(1), 1–14.
Wigal, J. K., et al. (1993). The knowledge, attitude, and self-efficacy asthma questionnaire. Chest, 104(4), 1144–1148.
Wigal, J. K., et al. (1993). The knowledge, attitude, and self-efficacy asthma questionnaire. CHEST Journal, 104(4), 1144–1148.
Juniper, E. F., et al. (1992). Evaluation of impairment of health related quality of life in asthma: Development of a questionnaire for use in clinical trials. Thorax, 47(2), 76–83.
Juniper, E. F., et al. (1999). Development and validation of the mini asthma quality of life questionnaire. European Respiratory Journal, 14(1), 32–38.
Mayo, N. E., Hum, S., & Kuspinar, A. (2013). Methods and measures: What’s new for MS? Multiple Sclerosis, 19(6), 709–713.
Nathan, R. A., et al. (2004). Development of the asthma control test: A survey for assessing asthma control. The Journal of Allergy and Clinical Immunology, 113(1), 59–65.
DeSalvo, K. B., et al. (2006). Mortality prediction with a single general self-rated health question. A meta-analysis. Journal of General Internal Medicine, 21(3), 267–275.
SAS. (2012). SAS enterprise guide. http://support.sas.com/documentation/onlinedoc/guide/.
Muthén, L. K., & Muthén, B. O. (2010) Mplus user’s guide. Muthén & Muthén.
Eagan, T. M. L., et al. (2002). Incidence of asthma and respiratory symptoms by sex, age and smoking in a community study. European Respiratory Journal, 19(4), 599–605.
Mancuso, C. A., Sayles, W., & Allegrante, J. P. (2010). Randomized trial of self-management education in asthmatic patients and effects of depressive symptoms. Annals of Allergy, Asthma & Immunology, 105(1), 12–19.
Kline, R. B. (2011). Hypothesis testing. In D. A. Kenny & T. D. Little (Eds.), Principles and practice of structural equation modeling (pp. 189–229). New York: Guilford Press.
Yu, C.-Y., & Muthén, B. (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes, in education. University of California.
Wang, J., & Wang, X. (2012) Introduction. In D. J. Balding, N. A. C. Cressie, G. M. Fitzmaurice, H. Goldstein, I. M. Johnstone, G. Molenberghs, D. W. Scott, A. F. M. Smith, R. S. Tsay, S. Weisberg (Eds.), Structural equation modeling: Applications using Mplus (p. 16). USA: Higher Education Press.
Muthén, B. et al. (1997). Robust inference using weighted least squares and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. Unpublished technical report.
Kline, R. B. (2011). Introduction. In D. A. Kenny & T. D. Little (Eds.), Principles and practice of structural equation modeling (pp. 3–18). New York: Guilford Press.
Emilsson, M., et al. (2011). The influence of personality traits and beliefs about medicines on adherence to asthma treatment. Primary Care Respiratory Journal, 20(2), 141–147.
FitzGerald, J. M., et al. (2006). Asthma control in Canada remains suboptimal: The Reality of Asthma Control (TRAC) study. Canadian Respiratory Journal, 13(5), 253–259.
Olajos-Clow, J., Costello, E., & Lougheed, M. D. (2005). Perceived control and quality of life in asthma: Impact of asthma education. Journal of Asthma, 42(9), 751–756.
Schachter, L. M., et al. (2001). Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax, 56(1), 4–8.
Hancock, G. R., & Freeman, M. J. (2001). Power and sample size for the root mean square error of approximation test of not close fit in structural equation modeling. Educational and Psychological Measurement, 61(5), 741–758.
Silva, G. E., et al. (2004). Asthma as a risk factor for COPD in a longitudinal study*. CHEST Journal, 126(1), 59–65.
WHO (2012) International Classification of Functioning, Disability and Health (ICF). [cited 2012 04/08/2012].
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Eilayyan, O., Gogovor, A., Mayo, N. et al. Predictors of perceived asthma control among patients managed in primary care clinics. Qual Life Res 24, 55–65 (2015). https://doi.org/10.1007/s11136-014-0700-1
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DOI: https://doi.org/10.1007/s11136-014-0700-1