Childhood Bronchial Asthma and Quality of Life

Asthma is the most common chronic disease in children, which restricts their physical, emotional, and social aspects of life. In North African countries including Egypt, asthma has a major negative impact on the daily activities of asthmatic children. It is approved that the assessment of quality of life (QOL) of asthmatic children is important for enhancing communication between health care providers and patient and it helps in monitoring of treatment. In developing countries, there are not enough data regarding the issue of quality of life especially among asthmatic children. A case control study design was used to investigate the quality of life among asthmatic children compared to non-asthmatic children at Mansoura city, Dakahlia, Egypt. The study included a total number of 392 children (196 children for each study and control group) who were interviewed at the outpatient clinic of Mansoura Chest Hospital. Socioeconomic level of the children's family was determined based on the scoring system of Fahmy and ElSherbini. A 5-point likert scale was developed according to the World Health Organization "Measurement of Quality of life in children". The study findings revealed a significant poor level of quality of life in relation to physical domain among the asthmatic children compared to non-asthmatic children. Severity of asthma showed a negative significant correlation with the level of quality of life in relation to the three domains. In conclusion, suffering from bronchial asthma negatively affects the children's quality of life, therefore there is a need special attention to provide information about measures to reduce daily activities restrictions.


INTRODUCTION
Bronchial asthma affects around 300 million people throughout the world (1,2) .
The prevalence of asthma is high in western countries and has been rising throughout the late 20 th century.It was estimated that the prevalence of asthma was 7.4% among children in Petersburg, and 9% among children in Spain (3,4) .In Tehran physicianconfirmed asthma was reported in 2.1% of the 6-7 year olds and 2.6% of the 13-14 age group. (5)The mean prevalence of asthma among Middle East countries and North African countries is 5.8% and 3.9% respectively in Egypt, bronchial asthma is affecting about 8.2% of children aged 3-15 years. (6)While the physician-diagnosed asthma was 9.4%, in Cairo (7) .Asthma is the most common chronic disease in children in developed countries that requires a considerable amount of health and social resources, as it is a heavy burden both for patients and their families and for society as well (8) .Asthma is the most common chronic pediatric disease that results in variable restriction in physical, emotional, and social aspects of the child's lif e (9) .It was found that asthma has a major impact on children's lives in Maghreb, and one in four of Egyptian children is unable to attend school regularly because of poor asthma control (10,11) .Quality of life (QOL) is a concept including the child and parents' subjective experience with the disease, providing information about how the condition affects everyday functioning and well-being. (12)Current ability to treat children with chronic disease, coupled with the inability to offer absolute cure, raises the issue of the quality of life of these children. (13)e assessment of QOL among children gives a better understanding on the children's feelings on their condition, and in enhancing communication between clinicians and patients that helps in the monitoring of treatment, in combination with clinical measures (9,14) .
Asthma is known to reduce the quality of life of its sufferers; however, there are no appropriate measures to estimate quality of life in developing countries with diverse cultural beliefs, and values (15) .
Accordingly, the present study aims to investigate the quality of life among asthmatic children compared to nonasthmatic children at Mansoura city.

Subjects and methods
Study design: Case control study design was used to explore the quality of life in asthmatic children compared to non-asthmatic children.

Study Setting:
The study was conducted at the outpatient chest clinic of chest hospital, affiliated to Ministry of Health at Mansoura city.

Study population and size:
Children who attended this clinic and fulfilling the study inclusion criteria were included.
The inclusion criteria of study participants are: Epiinfo statistical package version 6.00. (16)udy tools

1-A pre-designed interview sheet
Interview sheet was used to collect the following data from the child and or his/her parents: 1. Personal data: including age, sex, and socioeconomic data included education and occupations of Parents, crowding index and income.
The socioeconomic level of the children's family was determined based on the scoring system of Fahmy and El-Sherbini (1983) (17) .
Bull High Inst Public Health Vol.39 No. 3 [2009]   The total score ranged from 5 to 19.

2-Quality of life scale
Assessment quality of life's scale was developed according to the World Health Organization "Measurement of Quality of life in children" 1994 and The World Health Organization Quality of Life (WHOQOL)-BREF 2004 (19,20) .An Arabic Results: Asthmatic children describe asthma as a restricting factor of their life at school and recreational activities (22) .The present study indicated that asthmatic children showed a poor level of physical domain compared to non-asthmatic; however, the daily living of asthmatic children is negatively affected by asthma symptoms and dependency on medication.
Recurrent symptoms of asthma that need lifelong medication truly have an impact on children's quality of life (13) .This effect was revealed in their dissatisfaction with ability to play, sleeping pattern, and daily activities.Several studies have confirmed that the effects of asthma on quality of life, as reported by El-Fetouh et al (2009) who found that 73.0% children from North Africa were considered to be handicapped in their everyday activities always or most of the time because of asthma. (10).In addition, Jordanian as well as Taiwanese asthmatic children reported decreased exercise endurance and restrictions in relation to running and playing with friends. (23,24)Furthermore, Gent et al (2007) reported that scores of quality of life in children with a diagnosed asthma was lower than in children with undiagnosed asthma for all domains. (25)e psychosocial and environmental domains did not greatly differ in asthmatic children from non-asthmatic children included in this study.This could be interpreted on the highlight of the phenomena of the children belonging to lower socioeconomic class experience more life stressors (26) .However; nearly

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tested by forward and backward translation by a bilingual expert.The developed scale is a 5-point likert scale included 25 items that measure three main domains namely: physical, psychosocial and environment domains.The total scores of the scale are 110 scores.-Physical domain included eight items to measure how asthma interferes with physical activities mobility, daily functions and sleep pattern.This domain gained 40 scores -Psychosocial domain included eight items to measure interaction with friends, family, and playing, this domain gained 40 scores.-Environment domain included six items to measure safety and healthy living environment at home and school in addition to availability of food preferences, this domain gained 30 scores.Participants were asked to indicate how much they are "satisfied" or "bothered" with their life or how much asthma symptoms prevent them from doing activities in the last four weeks.The quality of life degree calculated for each domain and for allover quality of life scores as following: Poor quality of life = < 60% Good quality of life = ≥60% Methods: permission was obtained from Mansoura Chest Hospital which is affiliated to Ministry of Health, to collect data from outpatient clinic.b-Written consent was obtained from child's parents to enroll their children in the study.They were informed that all the obtained information would be analyzed anonymously and will be considered as confidential information.Development of the study tool: a-The researchers developed the interview sheet and Arabic version of quality of life measuring scale after reviewing recent literatures.b-Validity of the developed tools was tested by 4 experts in the field of pediatrics and community health.c-A pilot study was carried out on 15 children chosen randomly from the same outpatient clinic to ensure the clarity of the tools.d-Reliability of the scale was statistically tested by using alpha model test and the unrealistic questions were omitted.SPSS package (version 0.13) was used for the statistical analysis of the obtained data.Chi square test was used to illustrate the difference between asthmatic and non-asthmatic children regarding to their demographic characteristic and different quality of life items.Spearman test was used to estimate the correlation between the quality of life scores of each domain and the socioeconomic level and the degree of asthma.
half of the encountered study participants belonged to the low middle class and around one quarters are belonging to the low social class in asthmatic and nonasthmatic children.Furthermore, a positive correlation was found between the socioeconomic class of asthmatic children and their scores of the environmental domain.The grade of asthma was negatively correlated with the scores of the three quality of life domains, which is in agreement with Chapman (affects the children's quality of life, especially the components of physical domain namely sleeping pattern, as well as limited daily activities due to suffering from pain and dependency on treatment.It is recommended that asthmatic children need to be provided with information regarding healthy behaviors and measures to reduce restrictions on daily activities.In addition, further researches are required to explore the quality of life among asthmatic children in relation to the perception of their caregivers and health care providers.