Impact of Asthma on the Quality of Life of Adolescent Patients from Saudi Arabia

Full text

Impact of Asthma on the Quality of Life of Adolescent Patients from Saudi
Arabia
Halwani R1,2*, Al-kufeidy R1, Muharib BA1, Alkhashram FM1, Hussain SIB1, Alhenaki RS1, Vazquez-Tello A1, Al-Frayh A2, Iqbal SM2 and Al-Muhsen S1,2
1Prince Naif Center for Immunology Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
*Corresponding author: Rabih Halwani, Prince Naif Center for Immunology Research, Asthma Research Chair, College of Medicine, King Saud University, P. O. Box
2925, Riyadh, 11461, Saudi Arabia, Tel: +966-1-4690146; Fax: +966-1-4679463; E-mail: rhalwani@ksu.edu.sa
Received date: August 02, 2016; Accepted date: August 30, 2016; Published date: August 31, 2016
Copyright: © 2016 Halwani R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Bronchial asthma is a chronic inflammatory disease afflicting people worldwide without distinction
of age, gender or ethnicity. The health-related quality of life (HRQL) of adolescents with asthma can be disrupted
considerably and may reflect the effectiveness of symptoms management, therapy and health services provided.
Objective: To evaluate the health-related quality of life (HRQL) of Saudi Arab adolescents with documented
clinical history of asthma, classified by severity.
Methods: In this cross-sectional survey, the Pediatric Asthma Quality of Life (PAQLQ) and the Mini Asthma
Quality of life (Mini-AQLQ) questionnaires were applied to 135 randomly recruited asthma patients (11-to-19 years
old) in the period between January and June 2012, grouped as intermitent, mild, moderate, or severe.
Results: In 9 of 27 questions, significantly impaired HRQL was perceived by severe asthmatics, relative to
intermittent patients; in particular, almost all aspects of the symptoms category significantly bothered the severe
asthmatics. In emotional aspects, mild and moderates feel frustrated because couldn't keep up with others, whereas
in social activities, moderate and severe groups indicated worse scores in school attendance, relative to intermittent
asthmatics. In physical activities, severe and moderate groups reported lowest scores. A consistent finding was
related to the influence of environmental triggers: Dust, cigarette smoke and air pollution impaired HRQL of all four
asthma groups, relative to intermittent asthmatics.
Conclusion: Asthma lowers the health-related quality of life of Saudi adolescent patients, in terms of physical,
emotional, symptoms, and environmental triggers, impairing mainly the severe asthmatics.
Keywords: Pediatric asthma; Teenagers; Asthma severity;
Questionnaire; Quality of life score; Mini-AQLQ; PAQLQ
Introduction
Since the early 1960s, extensive epidemiological studies have
conrmed the rise in asthma prevalence, morbidity and mortality rates
in many countries and ethnic populations, thus becoming one of the
most common chronic pulmonary diseases in the world [1,2]. Asthma
aects not only the breathing capacity of patients, but also impacts
their health-related quality of life (HRQL), as dened by the general
well-being and happiness of the individual, in relation to physical,
emotional and social aspects [3-5].
Quality of life questionnaires aim to collect data as accurate as
possible, about a patient's symptoms and functioning on daily life.
Such information could in turn be used by physicians and caregivers to
evaluate the management of asthma and therapy ecacy [6-8]. In that
view, many studies around the world have investigated how asthma
aects HRQL of asthmatic patients. For instance, several studies have
found that asthmatic teenager girls have lower HRQL perception than
asthmatic boys; also, education about asthma disease and the proper
use of medication play an important role [9-11]. In general, asthmatics
have their daily life activities disrupted, such as attendance to
workplace and school, as well as limiting their basic physical and social
activities [10,12-14]. Furthermore, HRQL is more compromised in
patients with refractory asthma or requiring oral steroids [15].
Reportedly, steroid-resistant asthmatics are signicantly more
predisposed to anxiety and depression than patients with well
controlled symptoms, and experience fatigue, sleep disturbances and
have a general feeling of frustration [16]. erefore, higher rates of
hospitalization, more frequent visits to the emergency department
(ER), and poor HRQL self-assessment (e.g., reporting some
restrictions in daily activities), are characteristic of this subgroup [17].
In Saudi Arabia, approximately 11% of the population (of which
many are children and adolescents) suers from this disease [18]. So
far, no studies in Saudi Arabia have been done to investigate the
impact of asthma on the HRQL of adolescents. Although similar
surveys have been done in many countries, divergence in responses to
medical treatment suggest important cultural, gender and socio-
economic dierences; therefore, extrapolation of foreign results into
another society is discouraged [19]. Indeed, the Saudi society has
unique peculiarities, including linguistic, religious, cultural and health
care setting dierent in relation to Western societes, which justify this
work. In this cross-sectional survey, we interviewed adolescents with
asthma from Saudi Arabia, by using the highly reliable and fully
Journal of Lung Diseases & Treatment Halwani et al., Lung Dis Treat 2016, 2:3
DOI: 10.4172/2472-1018.1000114
Research Article Open Access
Lung Dis Treat, an open access journal
ISSN:2472-1018
Volume 2 • Issue 3 • 1000114

validated Pediatric Asthma Quality of Life questionnaire (PAQLQ) and
the Mini Asthma Quality of life Questionnaire (MiniAQLQ) [6,13].
e goal was to evaluate the impact of asthma severity symptoms and
environmental factors on the emotional, physical and social aspects of
life of Saudi adolescent patients.
Methods
Patients
A total of 135 adolescents, aged 11-19 years old and clinically
diagnosed with asthma and classied according to Guidelines by the
Global Initiative for Asthma in adolescents (GINA) [20], were
recruited at the Pediatric Asthma Clinic of the King Khalid University
Hospital in Riyadh, Saudi Arabia in the period between January and
June, 2012. Patients were randomly recruited at the time of their visit
to the clinic, during a period spanning 10 months. All patients were
evaluated by pulmonologists, who conrmed a documented clinical
history of asthma and follow-up visits, and were classied into 4
asthma severity groups according to GINA guidelines: Intermittent,
mild, moderate and severe [20]; because of the random recruitment,
no eort was done to equalize the size's groups. Criteria of eligibility
were: a) Be a Saudi citizen; b) Clinical history of at least one year of
asthma; c) Aged from 11 to 19 years old. Patients were excluded if they
presented other disorders or diseases, such as acute respiratory tract
infections in the past two weeks, or if they were tobacco smokers. e
study protocol was approved by the Institutional Review Board (IRB)
of the college of Medicine, King Saud University. All patients and
control subjects in this study signed an informed consent approved by
the IRB.
Study design and assessment of quality of life
Patients were invited to participate in this survey and an informed
written consent was signed from the parent/guardian before
administering the questionnaire. e study protocol was approved by
the Institutional Review Board (IRB) of the college of Medicine, King
Saud University. Patients were interviewed individually, face to face, in
a dedicated room whenever possible, to ensure condentiality and
privacy. e interviewer read the questions keeping in mind the
comprehensive capability of the patient/subject; a pilot reliability test
was also performed, using the entire questionnaire with a random
sample of asthmatics (n=12) to verify that they provided reliable
answers. Both the PAQLQ and the Mini-AQLQ overlap in many
questions; thus, the applied questionnaire contained all the questions
of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and
complemented with the Mini-AQLQ, for questions pertaining to
environmental triggers, which are absent in the PAQLQ [4,6,21]. Both
questionnaires are highly reliable and well validated tools translated
into many languages including Arabic, and cover the most important
and bothersome aspects aecting the daily lives of asthmatics [3,6,22].
Taking into consideration that Saudi Muslims have distinct cultural,
social activities and religious habits compared to Western countries,
authors decided to include three exploratory, non-validated questions,
to evaluate the potential negative impact of asthma on: a) e
performance of their religious customs; b) Whether asthma would
aect the choice of a career; and c) Whether asthma would aect their
work eciency.
Statistical analysis
HRQL score values for each question (variable) ranged from 1
(indicating maximum impairment) to 7 (no impairment at all) [4,6].
Both the mean scores and the total sums of scores for each question
were calculated. e overall score, which is the mean of all responses
per asthma severity group was also calculated. For each question item,
to determine possible signicant dierences in HRQL mean scores
among the four asthma severity groups, one-way ANOVA was
performed; when signicant dierences were detected (two-tailed
P<0.05), Dunnett's multiple comparison tests were performed by
comparing the HRQL mean scores of the intermittent group versus
those of the mild, moderate and severe groups. Equality of population
variances was conrmed through Bartlett's tests in all cases. Further, a
score analysis by categories (physical, emotional, social, symptoms,
environmental) was performed: For each category, the HRQL scores of
corresponding questions were summed up and the means calculated;
to determine signicant dierences among the 4 asthma severity
groups, one-way ANOVA tests were done; Dunnett's multiple
comparison tests were performed by comparing the intermittent
group's score versus those of the mild, moderate and severe asthma
groups. Signicant dierences were considered at two-tailed P values
<0.05 in all cases. Data were analyzed using SPSS and/or GraphPad
Prism soware packages.
Results
A total of 135 adolescents were recruited, which were asthma
patients classied into intermittent, mild, moderate or severe groups.
Principal demographic and clinical data of the recruited asthmatics are
presented in Table 1. ere were fewer severe asthmatics recruited,
whereas the largest group corresponded to the intermittent asthmatics;
because of the random recruitment procedure, no eort was made to
equalize the sample size of each group. e age of all asthmatic patients
averaged 14.6 years old (standard deviation of ± 2.3); the majority were
male students (58.5%), attending secondary school (60.7%).
Patients Age*
Gender ratios
Total subjects (%)
Scholar Education
M/F Primary Secondary High-School
Intermitent 14.5 ± 2.2 29/19 48 (35.5) 13 31 4
Mild-persistent 14.7 ± 2.2 27/15 42 (31.1) 9 30 3
Moderate-persistent 14.0 ± 2.4 17-Aug 25 (18.5) 9 13 3
Severe-persistent 15.3 ± 2.3 Jun-14 20 (14.8) 5 8 7
Citation: Halwani R, Al-kufeidy R, Muharib BA, Alkhashram FM, Hussain SIB, et al. (2016) Impact of Asthma on the Quality of Life of Adolescent
Patients from Saudi Arabia. Lung Dis Treat 2: 114. doi:10.4172/2472-1018.1000114
Page 2 of 6
Lung Dis Treat, an open access journal
ISSN:2472-1018
Volume 2 • Issue 3 • 1000114
* Mean age (years) ± S. Dev.
Table 1: Characteristics and frequencies of the recruited adolescent asthmatic patients.

Category Variables§
‡ HRQL scores by groups *P values
Intermittent
Mild Moderate Severe
Persistent persistent persistent
Physical activities
Q1. Strenuous activities 3.5 3.3 3 3.1 0.529
Q2. Moderate activities 2.6 2.9 2.4 3 0.475
Q3. Couldn’t keep up with
others 4.4 5 4.3 3.9 0.15
Q4. School-related activities 2.9 3.4 2.8 3.7(1) 0.004*
Emotional aspects
Q5. Feel frustrated 6.1 5.8 5.4 5.2 0.519
Q6. Feel afraid of not having
asthma medication available 5.6 6 4.8(1) 5.0(1) 0.04*
Q7. Feel worried, concerned
or troubled 5.5 5.2 5.2 5.1 0.364
Q8. Feel angry 5.6 4.9 5.4 4.4 0.119
Q9. Feel different or left out 6.6 5.8(1) 6.6 6.2 0.05
Q10. Feel frustrated because
couldn’t keep up with others 6.5 5.2(1) 5.3(1) 5.6 0.031*
Q11. Feel frightened by an
asthma attack 5.1 4.5 4.5 4 0.423
Asthma Symptoms
Q12. How much did coghing
bothered you 5 3 3.7 2.4(1) 0.021*
Q13. How much did
shortness of breath bothered
you
3.4 2.4(1) 2.9 2.1(1) 0.015*
Q14. How much did chest
tightness or chest heaviness
bothered you
4.4 3.4 3.7 3.0(1) 0.050*
Q15. How often did you have
trouble getting a good night's
sleep
4.6 4.4 4.7 3.9 0.403
Q16. How much did
wheezing bother you 4 4.3 3 2.8(1) 0.014*
Q17. How often did your
asthma wake up at night 5 4.0(1) 4.4 2.9(1) 0.031*
Q18. How often did you feel
out of breath 5.4 4.9 4.6 3.3(1) 0.004*
Q19. How often did you have
difficulty taking a deep breath 4.5 3.7 4.3 3.3 0.094
Environmental factors
Q20. Feel bothered by or
have to avoid dust 3 2.4 2.1 2 0.059
Q21. Feel bothered by or
have to avoid cigarette
smoke
2.7 2.6 2.6 2.7 0.995
Citation: Halwani R, Al-kufeidy R, Muharib BA, Alkhashram FM, Hussain SIB, et al. (2016) Impact of Asthma on the Quality of Life of Adolescent
Patients from Saudi Arabia. Lung Dis Treat 2: 114. doi:10.4172/2472-1018.1000114
Page 3 of 6
Lung Dis Treat, an open access journal
ISSN:2472-1018
Volume 2 • Issue 3 • 1000114

Q22. Feel bothered by or
have to avoid going outside
because of weather or air
pollution
3.7 4.2 3 3.1 0.145
Social activities
Q23. How limited have you
been doing social activities 2.5 2.9 3 4.1 0.069
Q24. How often did asthma
prevent you from going to
school
5 4.4 3.8(1) 3.5(1) 0.012*
Q25. How often did asthma
prevent you from performing
your religious duties
6.3 5.7 6.2 6.1 0.386
Q26. Feel that asthma will
affect your choice of a career 6.1 5.6 6 6.2 0.483
Q27. Feel that asthma will
affect your working efficiency 6.3 5.3(1) 6 6.2 0.024*
Overall scores 4.7 4.3 4.2 3.9 0.211
§The questions are listed in short form for the sake of space, keeping the essential keywords. ¶Overall scores: the mean of all responses per asthma severity groups.
*One-way ANOVA P values. Significance was considered at two-tailed P<0.05. ‡Dunnett's post-hoc tests, where scores from mild, moderate and severe groups
marked with (1) and highlighted with bold font were significantly different than those of intermittent group.
Table 2: Comparative analysis of HRQL mean scores by questions among asthma severity groups.
Table 2 shows a comparative analysis of the impact of asthma on
HRQL scores from patients classied in four dierent severity groups.
Multiple pairwise comparisons between the intermittent group versus
mild, moderate and severe asthma revealed signicant dierences in
13 out of 27 questions; most of them (9 questions) conrmed that
severe asthmatics (and sporadically moderate and mild asthmatics)
perceived their HRQL as more adversely aected in relation to
intermittent patients. is was particularly consistent in questions of
the asthma symptoms category: e aspects that bothered signicantly
the severe asthmatics more than intermittent asthmatics were
coughing (Q12), shortness of breath (Q13), chest tightness (Q14),
wheezing (Q16), night wakeups (Q17) and feel out of breath (Q18). In
contrast, in two particular questions, Q4 (school-related activities) and
Q23 (social activities), the results were the opposite, in the sense that
the severe group reported signicantly better scores than the other
groups with milder symptoms. Regarding the overall scores,
quantitative dierences greater than 0.5 in the 7-points scale, between
intermittent (4.7) and moderate (4.2) and severe (3.9) groups were
observed; although they were not statistically signicant (ANOVA, P
value=0.211), dierences of such magnitude are considered clinically
important [23].
e questions are listed in short form for the sake of space, keeping
the essential keywords. Overall scores: e mean of all responses per
asthma severity groups. *One-way ANOVA P values. Signicance was
considered at two-tailed P<0.05. ‡Dunnett's post-hoc tests, where
scores from mild, moderate and severe groups marked with (1) and
highlighted with bold font were signicantly dierent than those of
intermittent group.
e data were also analyzed by categories, in which the HRQL mean
sum of scores of the mild, moderate and severe groups were compared
to those of the intermittent group (Table 3). is test found signicant
dierences only within the symptoms category, indicating that the
mild, moderate and severe groups of patients had a worse perception
of their HRQL than that of the intermittent patients.
Categories
‡ HRQL Mean Sum scores ± SDev *P-
values
Intermittent Mild Moderate Severe -1
Physical
activities 8.95 ± 3.36 9.66 ±
3.94 8.28 ± 3.53 9.9 ± 5.27 0.424
Emotional
aspects 41.02 ± 8.03 37.42 ±
8.24
37.2 ±
10.55
35.4 ±
10.77 0.071
Asthma
Symptoms 34.93 ± 8.8 29.83 ±
10.15(1)
30.72 ±
9.14
23.35 ±
9.46(1) 0.0001*
Environmenta
l factors 9.41 ± 5.24 9.16 ±
4.81 7.72 ± 3.98 7.7 ± 5.24 0.34
Social
activities 26.25 ± 4.36 23.81 ±
5.06 25.0 ± 5.5 26.05 ±
6.6 0.139
*One-way ANOVA P values; ‡Dunnett's post-hoc tests; scores from mild,
moderate and severe groups marked with (1) and highlighted with bold font were
significantly different than those of intermittent group. Significance was
considered at two-tailed P<0.05
Table 3: Comparative analysis of HRQL sums of scores by categories.
Discussion
Asthma disease can result in varying degrees of restrictions in a
patient’s life, perceived in general as a lower quality of life which
includes physical, emotional and social aspects [6,8,9,13,15]. Although
many studies around the world have been conducted in order to
evaluate the impact of asthma on HRQL aspects of life [15,17,24,25], in
Saudi Arabia, analyses on the quality of life of adolescents with
dierent asthma severity symptoms are lacking.
Citation: Halwani R, Al-kufeidy R, Muharib BA, Alkhashram FM, Hussain SIB, et al. (2016) Impact of Asthma on the Quality of Life of Adolescent
Patients from Saudi Arabia. Lung Dis Treat 2: 114. doi:10.4172/2472-1018.1000114
Page 4 of 6
Lung Dis Treat, an open access journal
ISSN:2472-1018
Volume 2 • Issue 3 • 1000114

is study identied a number of questions from dierent
categories with better sensitivity at detecting HRQL score dierences
among the asthma groups. In general, (with two exceptions
mentioned) the detrimental eect of asthma on HRQL appeared to be
a function of its severity: Severe persistent asthmatics tended to be
more sensitive to environmental triggers, prone to disrupting
schooling activities, limiting strenuous physical activities (e.g., sports)
and complaining of many symptoms causing discomfort, in relation to
other asthma groups.
Specically, regarding physical aspects, scores for strenuous
activities (Q1) but not moderate activities (Q2) were diminished by
asthma in severe and moderate asthmatics, whereas mild and
intermediate asthmatics reported equivalent scores. Possibly, severe
and moderate asthmatics avoid strenuous exercise for fear of triggering
an exacerbation [26]. In contrast, the intermittent and mild asthmatics
do practice strenuous physical activities more frequently, suggesting
that their milder symptoms may not bother them enough. is is
supported by the lack of signicant dierences in Q2 (moderate
activities) and Q3 (couldn't keep up with others). In this respect, a
Portuguese team reported similarities in sedentary lifestyles between
adult asthmatics and healthy subjects: Depending on whether adult
male and female asthmatics achieved control of symptoms, these
patients did as much moderate and vigorous physical activities as
healthy subjects [27]. As an alternative explanation, some reports have
indicated that asthmatic children oen express denial at their inability
to have a normal life; for instance, some adolescents may have a 'risky'
behaviour, by forcing themselves to act 'normally', trying to t with
their peers in order to avoid exclusion or ostracism [28].
Regarding the impact of asthma on emotional aspects, our study
found that severe, moderate and mild groups were signicantly
aected in relation to intermittent asthmatics. In particular, severe and
moderate groups were worried about not having their medication
(Q6), whereas mild and moderate patients reported to feel frustrated
because couldn't keep up with others (Q10). ese nding contrasts
with other reports that found no correlation of HRQL scores with
emotional factors and that anxiety or depression do not always
associate with asthma [10,29]. Nevertheless, other investigators have
conrmed that exacerbations are truly detrimental to HRQL [3,9,15].
Furthermore, this study found that environmental factors such as
dust, smoke and air pollution exert an important eect, by consistently
lowering HRQL scores of all asthmatics; even though no signicant
dierences among the asthma groups were found, the observed trend
is to lower the scores, suggesting that these environmental triggers
could be bothersome for asthmatics. In fact, dust allergens are
considered a major environmental issue in Saudi Arabia [30].
Regarding social activities that were restricted by asthma, school
attendance (Q24) scores were signicantly worse in moderate and
severe patients, comparatively to intermittent asthmatics. However, the
severe asthma group not always reported the worse scores; in one
particular variable, limitation in performing social activities as a result
of asthma (Q23), this group of patients reported signicantly better
scores than the intermittent. Such unrestriction contrasts with
observations in childhood asthma; for instance in children from the
Netherlands, several social aspects were negatively inuenced by
asthma, and bullying by their peers was also reported [31]. It has been
argued that some asthma patients see themselves as leading normal
lives, but this could be a biased perception inuenced by adjustments
in their lifestyles imposed by disease [32]. In addition, by including
three exploratory non-validated questions, this study revealed that
asthma does not aect signicantly the performance of their religious
duties, nor induce concerns about their future job or career. Congruent
with these observations, a study from the Netherlands reported similar
HRQL scores between asthma adolescents and a reference control
group, in relation to self-reported psychosocial problems [33]. Another
study from the United States also failed to nd signicant dierences
on all psychosocial aspects between young asthma adult patients and
those with no chronic condition [34]. Evidently, asthma as a disease
may not be a major factor limiting the social life of Saudi adolescents;
this is congruent with reported changes in behaviour of adolescent
patients, who deny the seriousness of their disease, perhaps because
they fear to be perceived dierently from others [35]. In turn, such
'abnormal' behaviour could represent an obstacle in the diagnosis and
management of the disease [36].
Limitations and Future Research
Although valuable information was obtained directly from the
patients, and our main objective was achieved, potential shortcomings
in this study need to be addressed in the future. A characteristic of the
Saudi society is the practice of gender segregation, with women facing
restricted rights and inequalities in comparison to other countries of
the Middle East [37]; in contrast to men, for which there are no
restrictions in physical exercise or social activities, women have
mobility restrictions and limited or nil access to sport facilities.
erefore, since a predominance of female teenagers over males were
recruited in the severe groups, relative to the intermittent, mild and
moderate groups, we cannot exclude the possibility that this dierence
could have inuenced HRQL scores. Another limitation of this survey
is that it was not possible to collect information about their asthma
control status. Further research should focus on gender dierences, by
comparing HRQL of women and men in relation to asthma, and to
identify and characterize risk factors with greatest impact on HRQL
and how such factors could be prevented and managed. ese ndings
could help suggesting improvements on the Saudi medical system and
to direct health practitioners on ways to manage symptoms, so as to
improve the quality of life of patients.
Conclusion
is study showed that asthma lowers signicantly the quality of life
of Saudi asthmatic adolescents in several aspects, with environmental,
emotional and physical activities as being particularly inuenced. We
postulate that lack of symptoms control in intermittent and mild
asthmatics, contributes to lower HRQL perception; this hypothesis
deserves further analysis in the future.
Acknowledgement
is work was supported by the Deanship of Scientic Research at
King Saud University, Riyadh, Saudi Arabia.
Disclosure
All authors declare to have no nancial support that may pose
conicts of interest in relation to this article.
Author Contribution
RK, BAM, FM, SIH, RSA were responsible for the execution of the
study, interviewing patients and subjects, collection of data, and
performed a preliminary analysis and report. AVT performed the
Citation: Halwani R, Al-kufeidy R, Muharib BA, Alkhashram FM, Hussain SIB, et al. (2016) Impact of Asthma on the Quality of Life of Adolescent
Patients from Saudi Arabia. Lung Dis Treat 2: 114. doi:10.4172/2472-1018.1000114
Page 5 of 6
Lung Dis Treat, an open access journal
ISSN:2472-1018
Volume 2 • Issue 3 • 1000114

compilation of data, statistical analyses, and wrote the manuscript. AF,
MMS, SMI, SM, participated in the initial phase of planning and
design of the study, and analyzed the clinical history of the recruited
patients. RH was the main coordinator responsible in the design,
planning and reviewing of the preliminary report and nal
manuscript. All authors read and approved the nal manuscript.
References
1. De Sario M, Katsouyanni K, Michelozzi P (2013) Climate change,
extreme weather events, air pollution and respiratory health in Europe.
Eur Respir J 42: 826-843.
2. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, et al. (2008)
Allergic rhinitis and its impact on asthma (ARIA). Allergy 63: 8-160.
3. Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Grith LE, et al. (1996)
Measuring quality of life in children with asthma. Qual life Res 5: 35-46.
4. Reichenberg K, Broberg AG (2000) Quality of life in childhood asthma:
use of the Paediatric Asthma Quality of Life Questionnaire in a Swedish
sample of children 7 to 9 years old. Acta Paediatr 89: 989-995.
5. Moy ML, Israel E, Weiss ST, Juniper EF, Dube L, et al. (2001) Clinical
predictors of health-related quality of life depend on asthma severity. Am
J Respir Crit Care Med 163: 924-929.
6. Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR (1999) Development
and validation of the mini asthma quality of life questionnaire. Eur Respir
J 14: 32-38.
7. Leidy NK, Chan KS, Coughlin C (1998) Is the asthma quality of life
questionnaire a useful measure for low-income asthmatics?. Am J Respir
Crit Care Med 158: 1082-1090.
8. Osman LM, Calder C, Robertson R, Friend JA, Legge JS, et al. (2000)
Symptoms, quality of life, and health service contact among young adults
with mild asthma. Am J Respir Crit Care Med 161: 498-503.
9. Forrest CB, Stareld B, Riley AW, Kang M (1997) e impact of asthma
on the health status of adolescents. Pediatrics 99: 1-7.
10. Kolawole MS, Olayemi AF, Gregory EE, Abiodun AO, Daniel OO, et al.
(2011) Health related quality of life and psychological variables among a
sample of asthmatics in Ile-Ife South-Western Nigeria. Libyan J Med 6.
11. Nogueira KT, Silva JRL, Lopes CS (2009) Quality of life of asthmatic
adolescents: assessment of asthma severity, comorbidity, and life style.
Jornal de Pediatria 85: 523-530.
12. Kiotseridis H, Cilio CM, Bjermer L, Aurivillius M, Jacobsson H, et al.
(2013) Quality of life in children and adolescents with respiratory allergy,
assessed with a generic and disease-specic instrument. Clin Respir J 7:
168-175.
13. Moreira H, Carona C, Silva N, Frontini R, Bullinger M, et al. (2013)
Psychological and quality of life outcomes in pediatric populations: a
parent-child perspective. J Pediatrics 163: 1471-1478.
14. Basso RP, Jamami M, Labadessa IG, Regueiro EMG, Pessoa BV, et al.
(2013) Relationship between exercise capacity and quality of life in
adolescents with asthma. Jornal Brasileiro de Pneumologia 39: 121-127.
15. Lloyd A, Price D, Brown R (2007) e impact of asthma exacerbations on
health-related quality of life in moderate to severe asthma patients in the
UK. Prim Care Respir J 16: 22-27.
16. Rand CS, Butz AM, Kolodner K, Huss K, Eggleston P, et al. (2000)
Emergency department visits by urban African American children with
asthma. J Allergy Clin Immunol 105: 83-90.
17. Rosenman S, Rodgers B (2004) Childhood adversity in an Australian
population. Soc Psychiatry Psychiatr Epidemiol 39: 695-702.
18. Al Frayh AR, Shakoor Z, ElRab MG, Hasnain SM (2001) Increased
prevalence of asthma in Saudi Arabia. Ann Allergy Asthma Immunol 86:
292-296.
19. Ståhl E, Postma DS, Juniper EF, Svensson K, Mear I, et al. (2003) Health-
related quality of life in asthma studies. Can we combine data from
dierent countries? Pulm Pharmacol er 16: 53-59.
20. Bateman E, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, et al. (2008)
Global strategy for asthma management and prevention: GINA executive
summary. Eur Respir J 31: 143-178.
21. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, et al. (1992)
Evaluation of impairment of health related quality of life in asthma:
development of a questionnaire for use in clinical trials. orax 47: 76-83.
22. Abdel Hai R, Taher E, Fattah MA (2010) Assessing validity of the adapted
Arabic Paediatric Asthma Quality of Life Questionnaire among Egyptian
children with asthma. East Mediterr Health J 16: 274-280.
23. Juniper EF, Gruydd-Jones K, Ward S, Svensson K (2010) Asthma
Control Questionnaire in children: validation, measurement properties,
interpretation. Eur Respir J 36: 1410-1416.
24. Wilson SR, Rand CS, Cabana MD, Foggs MB, Halterman JS, et al. (2012)
Asthma outcomes: quality of life. J Allergy Clin Immunol 129: S88-S123.
25. Merikallio VJ, Mustalahti K, Remes ST, Valovirta EJ, Kaila M (2005)
Comparison of quality of life between asthmatic and healthy school
children. Pediatr Allergy Immunol 16: 332-340.
26. DiDario AG, Becker JM (2005) Asthma, sports, and death. Allergy
Asthma Proc 26: 341-344.
27. Verlaet A, Moreira A, Sá-Sousa A, Barros R, Santos R, et al. (2013)
Physical activity in adults with controlled and uncontrolled asthma as
compared to healthy adults: a cross-sectional study. Clin Transl Allergy 3:
1.
28. Rich M, Taylor SA, Chalfen R (2000) Illness as a social construct:
understanding what asthma means to the patient to better treat the
disease. Jt Comm J Qual Patient Saf 26: 244-253.
29. Janson C, Björnsson E, Hetta J, Boman G (1994) Anxiety and depression
in relation to respiratory symptoms and asthma. Am J Respir Crit Care
Med 149: 930-934.
30. Almogren A (2009) Airway allergy and skin reactivity to aeroallergens in
Riyadh. Saudi Med J 30: 392-396.
31. vanden Bemt L, Kooijman S, Linssen V, Lucassen P, Muris J, et al. (2010)
How does asthma inuence the daily life of children? Results of focus
group interviews. Health Qual Life Outcomes 8: 5.
32. Van Gent R, Essen-Zandvliet EEM, Klijn P, Brackel HJL, Kimpen JLL, et
al. (2008) Participation in daily life of children with asthma. J Asthma 45:
807-813.
33. Tibosch M, Reidsma C, Landstra A, Hugen C, Gerrits P, et al. (2010) An
asthma-related quality of life instrument is unable to identify asthmatic
children with major psychosocial problems. Eur J Pediatr 169: 1495-1501.
34. Berge JM, Bauer KW, Eisenberg ME, Denny K, Neumark-Sztainer D
(2012) Psychosocial and health behavior outcomes of young adults with
asthma or diabetes. J Community Med Health Educ 2: 144.
35. Sadof M, Kaslovsky R (2011) Adolescent asthma: a developmental
approach. Curr Opin Pediatr 23: 373-378.
36. Rietveld S, Creer TL (2003) Psychiatric factors in asthma: implications for
diagnosis and therapy. Am J Respir Med 2: 1-10.
37. Mobaraki AEH, Söderfeldt B (2010) Gender inequity in Saudi Arabia and
its role in public health/L'inégalité entre hommes et femmes en Arabie
saoudite et ses conséquences sur la santé publique. East Mediterr Health J
16: 113-118.
Citation: Halwani R, Al-kufeidy R, Muharib BA, Alkhashram FM, Hussain SIB, et al. (2016) Impact of Asthma on the Quality of Life of Adolescent
Patients from Saudi Arabia. Lung Dis Treat 2: 114. doi:10.4172/2472-1018.1000114
Page 6 of 6
Lung Dis Treat, an open access journal
ISSN:2472-1018
Volume 2 • Issue 3 • 1000114