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a Aintree Chest
Centre, University Hospital Aintree, Liverpool L9 7AL, UK, b Division of Biological Sciences, University of
Salford, Salford M5 4WT, UK
Correspondence to: L D Rimington, School of Health Care Professions, University of Salford, Frederick Road Campus, Salford M6 6PU, UK L.Rimington{at}salford.ac.uk
Received 3 March 2000; Returned to authors 25 May 2000; Revised version received 23 October 2000; Accepted for publication 20 December 2000
BACKGROUND
Symptoms
of disease reported by patients reflect the effects of the disease
process within the individual and the person's physical and mental
ability to tolerate or otherwise cope with the limitations on their
functioning. This study examines the relationship between asthma
symptoms, disease severity, and psychological status in patients being
managed in routine primary healthcare settings.
METHODSOne
hundred and fourteen subjects from four GP practices, two inner city
and two suburban, were studied. Symptoms were assessed by means of the
Asthma Quality of Life questionnaire (AQLQ) and a locally devised Q
score, and psychological status with the Hospital Anxiety and
Depression (HAD) scale. Spirometric values and details of current
asthma treatment (BTS asthma guidelines treatment step) were
recorded as markers of asthma severity.
RESULTSSymptoms as
measured by AQLQ correlated with peak expiratory flow
(rS = 0.40) and with BTS
guidelines treatment step (rS = 0.25). Similarly, the Q score correlated with peak expiratory flow
(rS = 0.44) and with BTS
guidelines treatment step (rS = 0.42). Similar levels of correlation of forced expiratory volume in one
second (FEV1) with symptoms were reported. HAD anxiety and
depression scores also correlated to a similar extent with these two
symptom scores, but there was hardly any correlation with lung
function. Logistic regression analysis showed that HAD scores help to
explain symptom scores over and above the effects of lung function and
BTS guidelines treatment step. Symptoms, depression, and anxiety were
higher for inner city patients while little difference was observed in
objective measures of asthma.
CONCLUSIONSAsthma
guidelines suggest that changing levels of symptoms should be used to
monitor the effectiveness of treatment. These data suggest that
reported symptoms may be misleading and unreliable because they may
reflect non-asthma factors that cannot be expected to respond to
changes in asthma treatment.
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