title: Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma.
abstract: BACKGROUND
  Few data are available that evaluate the relationship among asthma exacerbations, asthma triggers, and asthma-related quality of life (QoL).
  
  
  OBJECTIVE
  To evaluate the impact of asthma exacerbations and asthma triggers on QoL.
  
  
  METHODS
  Patients with severe or difficult-to-treat asthma, ages ≥ 13 years (n = 2679) from the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) 3-year observational study were included. Exacerbations were defined hierarchically in descending order of severity (hospitalization, emergency department [ED] visit, steroid burst, no exacerbation) by using data from months 6 and 12. The total number (frequency) of exacerbations was assessed. Asthma-related QoL was measured at month 12 by using the Mini-Asthma QoL Questionnaire (Mini-AQLQ); self-reported asthma triggers were collected at baseline and annually. We used 1-way ANOVA to test for differences in Mini-AQLQ domain scores across asthma exacerbation severity, the total number of asthma exacerbations, and the number of asthma triggers.
  
  
  RESULTS
  A significant decrease (P < .001) in Mini-AQLQ domain scores was seen with increasing severity of asthma exacerbation (no exacerbation, steroid burst, ED visit, and hospitalization); symptom (5.5, 4.8, 4.3, and 4.2), activity (5.8, 5.2, 4.6, and 4.4), emotional (5.6, 5.0, 4.4, and 4.2), exposure (5.0, 4.5, 4.0, and 3.9); and overall (5.5, 4.9, 4.3, and 4.1). Increasing exacerbation frequency and the number of baseline asthma triggers also were associated with significant decreases in Mini-AQLQ domain scores. An increasing number of asthma triggers were associated with an increase in severity and frequency of exacerbations.
  
  
  CONCLUSIONS
  Avoidance of asthma triggers may reduce exacerbation rates and improve asthma-related QoL in patients with severe or difficult-to-treat asthma. Interventional studies are warranted to further explore these outcomes.
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, Wis. Electronic address: allan_luskin@hotmail.com.
authors.forename: Allan T
authors.initials: AT
authors.lastname: Luskin
authors.affiliation: Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Chipps
authors.affiliation: Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rasouliyan
authors.affiliation: Late Phase and Outcomes Research, ICON Clinical Research, San Francisco, Calif.
authors.forename: Dave P
authors.initials: DP
authors.lastname: Miller
authors.affiliation: US Medical Affairs, Genentech, Inc., South San Francisco, Calif.
authors.forename: Tmirah
authors.initials: T
authors.lastname: Haselkorn
authors.affiliation: Department of Pediatric Immunology and Allergy, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Dorenbaum
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Allergic triggers; Difficult-to-treat asthma; Quality-of-life; Severe asthma