Quality of life and activity of children suffering from bronchial asthma

Abstract

The aim of this article was to analyze the quality of life of children suffering from bronchial asthma and to analyze their everyday activity.
The research was conducted in 137 children. The following questionnaires were used in the study: Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and a questionnaire designed by the authors specifically for the purpose of the study.
The findings of the study show that illness duration (r = -0.2; P = 0.22) and gender (P = 0.37) do not influence the quality of life. It appears that among children ill with asthma a higher level of quality of life is typical for the children who live in the country side in comparison with those from cities (P <0.05). The comparison was also made in terms of everyday activity of children ill with asthma and non-asthmatic children. The children ill with asthma displayed less social contacts with peers/friends (P <0.05) and they performed less physical activities (P <0.05).
The study points to the possible beneficial effects of activating children's social interactions, creating conditions for appropriate development of their social competences, and of stress reduction connected with social interactions. Asthmatic children should also be encouraged to intensify appropriate physical activity.

Full text

Abstract
Objectiv e: The aim of this article was to analyze the
quality of life of children suffering from bronchial
asthma and to analyze their everyday activity.
Methods: The research was conducted in 137 children.
The following questionnaires were used in the study:
Pediatric Asthma Quality of Life Questionnaire
(PAQLQ) and a questionnaire designed by the authors
specifically for the purpose of the study.
Results: The findings of the study show that illness
duration (r = -0.2; P = 0.22) and gender (P = 0.37) do
not influence the quality of life. It appears that among
children ill with asthma a higher level of quality of
life is typical for the children who live in the country
side in comparison with those from cities (P <0.05).
The comparison was also made in terms of everyday
activity of children ill with asthma and non-asthmatic
children. The children ill with asthma displayed less
social contacts with peers/friends (P <0.05) and they
performed less physical activities (P <0.05).
Conclusions: The study points to the possible beneficial
effects of activating children’s social interactions, creat-
ing conditions for appropriate development of their so-
cial competences, and of stress reduction connected
with social interactions. Asthmatic children should also
be encouraged to intensify appropriate physical activity.
Key words: bronchial asthma, quality of life
INTRODUCTION
The aim of this article is to analyze the quality of life
and everyday activity of children suffering from
bronchial asthma. Childhood is a period when many
models of behavior – implemented later on in life –
are formed. Therefore, it is worthwhile to consider
how children’s chronic disease influences their evalua-
tion of life quality and social activity [1, 2].
Civilization development and increase in environ-
ment pollution lead to an increase in the occurrence of
allergic diseases, including bronchial asthma. WHO re-
ports that 300 million people suffer from asthma
world wide. The International Study of Asthma and
Allergies in Childhood (ISAAC) carried out in the
1990s show that asthma affects 7.2% of children aged
6-7 and 11.3% of those aged 13–15. Progressive in-
crease in the incidence of asthma makes this condition
the most prevalent chronic disease of the respiratory
system in children [3].
The disease, along its course, evokes varying emo-
tions in children; the negative ones prevailing. Emo-
tional disorders are experienced by 25–40% of asth-
matic children; most often consisting of excessive psy-
chological dependence on the parents and increased
anxiety level [4]. Parents often tend to act incorrectly
in such situations. They are overprotective, assume
rigid attitudes, and get too much involved in other
family members’ lives. Overprotection impedes the
child’s emotional development, disturbs the develop-
ment of self-reliance and independence. Excessive
family concentration on the affected child leads to the
lack of independence, egocentrism, and infantilism.
The child starts to exert pressure on the family, where-
as, when separated from the family, he is not self-con-
fident and new situations trigger anxiety reactions [2].
Reducing everyday duties and permanent supervision
of the child result in difficulties in adoption to living
in the society [5, 6, 7].
The child’s chronic disease also may disturb the
learning process. Difficulties at school may result
from several factors, such as the medicines taken, the
absenteeism due to disease exacerbation or hospital-
izations. Oral glucocorticosteroids may disturb the
cognitive processes or cause sleep disturbances, plain-
tiveness, anxiety, or depression. Beta2-adrenergic ago-
nists, in turn, may cause muscles trembling and may
be the reason for illegible handwriting. Sleepiness, de-
creased concentration, and fatigue are just some of
the other side effects resulting from antihistaminic
medicines.
Incorrectly controlled asthma, in its turn, or more
severe forms of the disease may lead to lasting nightly
complaints which, by disturbing child’s sleeping, have
an impact on both physical and mental functioning.
MATERIAL AND METHODS
The study protocol was approved by an institutional
Ethics Committee. The following questionnaires were
used for the study: Pediatric Asthma Quality of Life
Questionnaire (PAQLQ) and a self-developed ques-
tionnaire addressed to both healthy and asthmatic chil-
dren. The PAQLQ was used for the identification of
negative physical, emotional, and social effects chil-
dren suffering from asthma could be exposed to. The
questionnaire enables to survey children aged 7-17. It
consists of 23 items, including three domains: symp-
toms, emotions, and activity limitation. By summing
EUROPEAN JOURNAL OF MEDICAL RESEARCHDecember 7, 2009 147
Eur J Med Res (2009) 14(Suppl. IV): 147-150 © I. Holzapfel Publishers 2009
QUALITY OF LIFE AND ACTIVITY OF CHILDREN SUFFERING FROM BRONCHIAL
ASTHMA
A. Trzcieniecka-Green1, K. Bargiel-Matusiewicz2, A. Wilczynska-Kwiatek3
1Department of Psychology, Silesian Medical University, Katowice, Poland; 2Faculty of Psychology, Warsaw University, Warsaw, Poland;
3Faculty of Psychology, Silesian University, Katowice, Poland
S. I-X, 1-284:Layout 1 24.11.2009 10:43 Uhr Seite 147

up the score from these domains, a coefficient pertain-
ing to the general quality of life (QL) is obtained [8,
9].
Another tool was a self-developed questionnaire. It
was directed to healthy children and children suffering
from bronchial asthma. It is complementary with the
PAQLQ. The goal is to gain information about every-
day activity of children covered by the survey (con-
tacts with age-mates, watching TV, time spent on using
computer, reading books, physical activity) and to col-
lect demographic data.
The survey was conducted on 137 Polish children
from Katowice, Chorzów, Tarnowskie Góry and
neighboring villages. There were 37 children suffering
from bronchial asthma and 100 healthy children in the
group. Children suffering from bronchial asthma, for
whom at least a year had passed from the moment
they were diagnosed with the condition, were selected
to participate in the survey. There were slightly more
girls in the whole group (52%). However, girls made
up 55% of the healthy children, whereas boys domi-
nated among the asthmatic children (57%). The
youngest children in the survey were 7 and the oldest
were 14 years old. The average age of the whole group
was 10.6; it was 10.7 in the asthmatic children and 10.6
in the healthy ones.
RESULTS
Before calculations regarding the relation between the
Quality of Life (QL) and other parameters were made,
the results of the PAQLQ questionnaire had been ver-
ified. The aim was to define the relation between vari-
ous results of individual sub-scales of this question-
naire (symptoms, emotions, and activity limitation)
and the general result referred to as QL. To this end,
coefficients of linear correlation were calculated be-
tween the results of sub-scales and the general result.
As the correlations proved to be very strong (symp-
toms r = 0.96; emotions r = 0.95; activity limitation r
= 0.94), it was assumed that the variables were actually
univocal with the QL variable.
With reference to the above outlined, in further
analyses, a comparison of the disease duration, place
of living, and gender, on one hand, with the general
result of PAQLQ, on the other hand, was made. Fig. 1
shows that there was a weak, negative correlation be-
tween disease duration and quality of life, which lacks
statistical significance (r = -0.2; P = 0.22). Next, a rela-
tion between the place of living and QL was analyzed.
For this purpose, the significance of differences in QL
assessed by children living in the city and in the coun-
try was statistically verified. The results are presented
in Table 1. It was found that in the case of children
suffering from bronchial asthma, the children living in
the country assessed their QL higher than those living
in the city.
Further, the relation between the gender and QL
was analyzed. These results, presented in Table 2,
show that the differences in QL between girls and
boys suffering from bronchial asthma were statistically
irrelevant.
Finally, everyday functioning of children suffering
from bronchial asthma and their age-mates was evalu-
ated. The comparison encompassed the following:
how much time was spent on different activities -
reading books, watching TV, meeting friends (after
school), time spent for computer games, and physical
activities. The results of this comparison are presented
in Table 3.
EUROPEAN JOURNAL OF MEDICAL RESEARCH
148 December 7, 2009
Tab le 1. Differences in Quality of Life (QL) of children living in the city and in the country.
Sum of ranks – QL in the city Sum of ranks – QL in the country U Statistics Pn
262.5 440.5 72.5 <0.05 City 19
Country 18
QL – quality of life; Mann-Whitney-U test.
Fig. 1. Relation between the duration of disease
and quality of life.
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The differences concerning the average time devot-
ed for reading books, watching TV, and using comput-
ers in asthmatic vs. healthy children were insignificant.
Yet, remarkable statistical differences were found with
reference to the average time spent with friends after
school and that devoted to physical activities (117 vs.
35 min for social interaction and 144 vs. 81 min for
physical activities in healthy and asthmatic children, re-
spectively). Statistical elaboration of these results is
presented in Tables 4 and 5.
DISCUSSION
The present study failed to substantiate the existence
of significant relationships between gender of chil-
dren suffering from asthma or the duration of disease
and their quality of life. The lack of such relationships
is in accord with other studies on the subject [5]. What
turned out to be significant was the relation between
the place of living and quality of life of asthmatic
children. It was found that children living in the coun-
try assessed their quality of life better than those from
the city. A better assessment of quality of life among
country children may result from a few factors, such as
a slower pace of life, less pressure of time, and there-
fore less associated stress. Children living in the coun-
try spend more time with their parents who give them
more support. They may also be supported by their
grandparents, who live in common households much
more often than in case of cities. Another reason for a
feeling of a better quality of life in these children may
be less polluted natural environment in the country,
which in case of asthma directly translates to the fre-
quency of respiratory symptoms.
Concerning everyday functioning of children, the
analysis shows that both asthmatic and non-asthmatic
children spend a comparable amount of time on read-
ing books, watching TV, and using computer. Yet, a
significant difference appeared concerning the time
spent on socializing with friends after school. Healthy
children tend to spend remarkably more time with
their friends than the asthmatic ones, on average, 117
min vs. 35 min, respectively. Thus, it seems to be im-
portant to encourage children suffering from asthma
to intensify social activity, to engage in contact with
age-mates, and to do so not only at school, but also af-
ter classes. Proper social relations constitute an essen-
tial factor in the process of forming the self-assess-
ment and the sense of self-efficacy, which are of cru-
cial meaning for functioning in many areas of life [1,
7]. Beside, there is a risk that a child who spends little
time with age-mates will experience much more stress
EUROPEAN JOURNAL OF MEDICAL RESEARCHDecember 7, 2009 149
Tab le 3. Comparison of physical activities of healthy children and children suffering from bronchial asthma.
n%Reading books Watching TV Meeting friends Computer Physical activities
(min) (min) (min) (min) (min)
Healthy children 100 73 52 113 117 112 144
Asthmatic children 37 27 62 120 35 100 81
Tab le 2. Significance of differences between Quality of Life (QL) of girls and boys.
Sum of ranks - QL among girls Sum of ranks - QL among boys U Statistics Pn
369.5 333.5 138.5 P = 0.37 girls 21;
boys 16
QL – quality of life; Mann-Whitney-U test.
Tab le 4. Significance of differences concerning the time spent with friends.
Sum of ranks – Asthmatic Children Sum of ranks – Healthy Children U Statistics Pn
1344.5 8108.5 641.5 P<0.05 Asthmatic - 37
Healthy - 100
Mann-Whitney- U test.
Tab le 5. Significance of differences concerning physical activities.
Sum of ranks – Asthmatic Children Sum of ranks – Healthy Children U Statistics Pn
1721.0 7732.0 1018.0 P<0.05 Asthmatic - 37
Healthy - 100
Mann-Whitney- U test.
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in the situations of social interactions than persons for
whom social contacts are something normal in every-
day functioning. Many authors claim that stress and
negative emotions can trigger and exacerbate the
symptoms of asthma [2, 10, 11]. It is worth mention-
ing that sanatorium treatments have a positive influ-
ence on social skills. Staying in this kind of facilities al-
lows establishing new friendships, and therapeutic
classes not only develop new skills, but also allow
overcoming emotional stresses often accompanying
the disease. Contact with other children suffering from
bronchial asthma allows sharing one’s experiences with
others and to find out about the way others deal with
the condition.
There also was a significant difference concerning
physical activity between asthmatic and healthy chil-
dren to the disadvantage of the sick; on average, 81 vs.
114 min, respectively. Admittedly, it is a detrimental
occurrence and may result from incorrect convictions
of parents or teachers, and passed onto children, that
physical activity should be shunned or disadvised in
asthma, due either to reduced children’s capability or
the possibility of asthma aggravation. Research shows
that doing sports by people suffering from asthma,
under appropriate pharmacological umbrella, reduces
bronchial hyperreactivity and improves physical effi-
ciency. However, not every sport discipline is recom-
mended to children suffering from asthma. Due to
high minute ventilation, they should avoid such sports
as basketball, cycling racing, long-distance races, or
other high-performance sports. Exposure to cold and
dry environment while doing sports is not recom-
mended either. What is recommended are the disci-
plines where effort is spread over time, e.g., swim-
ming, riding a bike, gymnastics, or canoeing. The diag-
nosis of bronchial asthma does not mean at all that a
child should lead sedentary life and resign from the
benefits of physical activity. Activity is not only a per-
fect way to be in a good shape, enjoy good health, but
also to keep good mental condition (12). Previous re-
search shows that what is essentially important con-
cerning physical activity is the perceived competence
at it and attitude toward it (14). Therefore, it is crucial
to help shape positive attitude toward physical activity
in children with asthma.
In summary, the present survey may help shape atti-
tudes toward functioning of children suffering from
asthma. Such children should be encouraged to the in-
teractions on social level, which would create condi-
tions for appropriate development of their social com-
petences and to reduce stress connected with such in-
teractions. They also should be encouraged to intensi-
fy physical activity taking into account recommenda-
tions as to the forms of activity suitable for these chil-
dren.
Conflicts of interest: The authors reported no conflicts of in-
terest in relation to this article.
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Corr espo nding a uthor:
Kamilla Bargiel-Matusiewicz
Faculty of Psychology
Warsaw University
Stawki 5/7 St.
00-183 Warsaw, Poland
Phone: +48 22 5549703
E-mail: K.matusiewicz@op.pl
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