Improvement in asthma quality of life in patients enrolled in a prospective study to increase lifestyle physical activity.

OBJECTIVE: Asthma patients know the benefits of exercise but often avoid physical activity because they are concerned that it will exacerbate asthma. The objective of this analysis was to assess longitudinal asthma status in 256 primary care patients in New York City enrolled in a trial to increase lifestyle physical activity. METHODS: Patients were randomized to two protocols to increase physical activity during a period of 12 months. At enrollment, patients completed the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) and received asthma self-management instruction through an evaluative test and workbook. Exercise and self-management were reinforced every 2 months. The AQLQ was repeated every 4 months and the ACQ was repeated at 12 months. RESULTS: The mean age was 43 years and 75% were women. At 12 months there were clinically important increases in physical activity with no differences between groups; thus, data were pooled for asthma analyses. The enrollment AQLQ score was 5.0 ± 1.3 and increased to 5.9 ± 1.1 corresponding to a clinically important difference. Correlations between AQLQ and physical activity were approximately 0.35 (p < .0001) at each time point. In a mixed effects model, the variables associated with improvement in AQLQ scores over time were male sex, less severe asthma, not taking asthma maintenance medications, fewer depressive symptoms, and increased physical activity (all variables, p < .03). According to the ACQ, asthma was well controlled in 38% at enrollment and in 60% at 12 months (p < .0001). CONCLUSION: With attention to self-management, increased physical activity did not compromise asthma control and was associated with improved asthma.

Increasing physical activity in patients with asthma through positive affect and self-affirmation: a randomized trial.

BACKGROUND: Patients with asthma engage in less physical activity than peers without asthma. Protocols are needed to prudently increase physical activity in asthma patients. We evaluated whether an educational intervention enhanced with positive-affect induction and self-affirmation was more effective than the educational protocol alone in increasing physical activity in asthma patients. METHODS: We conducted a randomized trial in New York City from September 28, 2004, through July 5, 2007; of 258 asthma patients, 252 completed the trial. At enrollment, control subjects completed a survey measuring energy expenditure, made a contract to increase physical activity, received a pedometer and an asthma workbook, and then underwent bimonthly follow-up telephone calls. Intervention patients received this protocol plus small gifts and instructions in fostering positive affect and self-affirmation. The main outcome was the within-patient change in energy expenditure in kilocalories per week from enrollment to 12 months with an intent-to-treat analysis. RESULTS: Mean (SD) energy expenditure at enrollment was 1767 (1686) kcal/wk among controls and 1860 (1633) kcal/wk among intervention patients (P = .65) and increased by 415 (95% CI, 76-754; P = .02) and 398 (95% CI, 145-652; P = .002) kcal/wk, respectively, with no difference between groups (P = .94). For both groups, energy expenditure was sustained through 12 months. No adverse events were attributed to the trial. In multivariate analysis, increased energy expenditure was associated with less social support, decreased depressive symptoms, more follow-up calls, use of the pedometer, fulfillment of the contract, and the intervention among patients who required urgent asthma care (all P < .10, 2-sided test). CONCLUSIONS: A multiple-component protocol was effective in increasing physical activity in asthma patients, but an intervention to increase positive affect and self-affirmation was not effective within this protocol. The intervention may have had some benefit, however, in the subgroup of patients who required urgent asthma care during the trial. Trial Registration clinicaltrials.gov Identifier: NCT00195117.

Obesity and exercise habits of asthmatic patients.

BACKGROUND: National guidelines recommend 20 to 30 minutes of exercise 3 to 5 days a week. However, achieving these goals may be challenging for asthmatic patients whose symptoms are exacerbated by exercise. OBJECTIVE: To describe relationships among exercise habits, weight, and asthma severity and control in adults with asthma. METHODS: Self-reported exercise habits were obtained from 258 stable patients by using the Paffenbarger Physical Activity and Exercise Index. Disease status was measured by using the Asthma Control Questionnaire and the Severity of Asthma Scale. Exercise habits were evaluated in multivariate analyses with age, sex, education, body mass index, and asthma control and severity as independent variables. RESULTS: The mean patient age was 42 years; 75% were women, 62% were college graduates, and 40% were obese. Only 44% of patients did any exercise. In bivariate analysis, patients with well-controlled asthma were more likely to exercise; however, in multivariate analysis, asthma control and severity were not associated, but male sex (P = .01), having more education (P = .04), and not being obese (P < .001) were associated. Asthma control and severity also were not associated with type, duration, or frequency of exercise, but not being obese was associated in multivariate analyses. Only 22% of all patients (49% of those who exercised) met national guidelines for weekly exercise. Not being obese was the only variable associated with meeting guidelines in multivariate analysis (P = .02). CONCLUSIONS: Compared with the general population, a lower proportion of asthmatic patients did any routine exercise and met national exercise guidelines. Physicians need to manage asthma and obesity to help asthmatic patients meet exercise goals.

Beliefs about asthma medications: patients perceive both benefits and drawbacks.

Patients have diverse beliefs about asthma medications that may be influenced by asthma characteristics. The objective of this qualitative analysis was to identify patients' beliefs about asthma medications and to assess these beliefs according patient and asthma characteristics, including asthma severity and patient-reported medication adherence. From interviews with 52 patients (mean age 43 years, 87% women, 71% taking maintenance medications), 17 categories of beliefs about medications were discerned which were grouped into perceived benefits (e.g., permit activities, thwart symptoms) and perceived drawbacks (e.g., establish a medication routine, ensure supply). Beliefs were not mutually exclusive, with 56% of patients citing both benefits and drawbacks. Beliefs did not differ based on asthma severity or type of current therapy, however, patients who cited drawbacks were more likely to have worse self-reported Morisky Medication Adherence Questionnaire scores (possible range 0-4, higher is worse adherence) compared to those who did not cite drawbacks (1.9 +/- 1.3 vs 0.9 +/- 0.9; p = .02). Providers should be aware of patients' beliefs about medications in order to reinforce perceived benefits and address perceived drawbacks.

Psychological and somatic symptoms in screening for depression in asthma patients.

Correctly identifying asthma patients who need treatment for depression is part of comprehensive care. The objective of this study was to compare the prevalence of depressive symptoms measured by the short-form Center for Epidemiologic Studies Depression Scale (CESD-SF), which measures somatic and psychological symptoms, with the original and short-form Geriatric Depression Scale (GDS and GDS-SF), which measure only psychological symptoms. In total, 257 asthma patients (mean age 42 years, 75% women) completed the GDS (score range 0-30, positive screen > or = 11) and the CESD-SF (score range 0-30, positive screen > or = 10). The performance of each scale was compared to clinical diagnoses of depressive disorders reported by physicians using a skill score analysis. Twenty percent of patients had GDS scores > or = 11 and 32% had CESD-SF scores > or = 10. The somatic symptom of restless sleep was the most common CESD-SF symptom and the symptom that contributed most to the total score. The GDS had a skill score of +.16 (+1 = maximum possible, 0 = best guess) and the CESD-SF had a skill score of -.02 compared to physician-reported depressive disorders. Similar results were found for the GDS-SF. Thus, more patients had a positive CESD-SF screen, which was attributable mostly to a somatic sleep symptom that overlaps with asthma symptoms, and the GDS was more consistent with physicians' reports of depressive disorders.

Patient-reported and physician-reported depressive conditions in relation to asthma severity and control.

BACKGROUND: Depressive conditions in asthma patients have been described mostly from patient reports and less often from physician reports. While patient reports can encompass multiple symptoms, physician assessments can attribute symptoms to a mental health etiology. Our objectives were to identify associations between patient- and physician-reported depressive conditions and asthma severity and control. METHODS: Patient-reported depressive symptoms were obtained using the Geriatric Depression Scale (GDS) [possible score 0 to 30; higher score indicates more depressive symptoms]. Patients were categorized as having a physician-reported depressive disorder if they had the following: a diagnosis of depression, depressive symptoms described in medical charts, or were prescribed antidepressants at doses used to treat depression. Patients also completed the Severity of Asthma Scale (SOA) [possible score 0 to 28; higher score indicates more severe] and the Asthma Control Questionnaire (ACQ) [possible score 0 to 6; higher score indicates worse control]. RESULTS: Two hundred fifty-seven patients were included in this analysis (mean age, 42 years; 75% women). Mean SOA and ACQ (+/- SD) scores were 5.9 +/- 4.2 and 1.4 +/- 1.2, respectively; and mean GDS score was 6.3 +/- 6.4. After adjusting for age, sex, race, Latino ethnicity, education, medication adherence, body mass index, and smoking status, patient-reported depressive symptoms were associated with asthma severity (p = 0.007) and with asthma control (p = 0.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p = 0.04) but not with asthma control (p = 0.22) after adjusting for covariates. CONCLUSIONS: Physician- and patient-reported depressive conditions were associated with asthma severity. In contrast, patient-reported depressive symptoms were more closely associated with asthma control than were physician-reported depressive disorders. Identifying associations between depressive conditions and asthma severity and control is necessary to concurrently treat these conditions in this population. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT00195117.

Measuring physical activity in asthma patients: two-minute walk test, repeated chair rise test, and self-reported energy expenditure.

Although prudent exercise is recommended for most patients with well-controlled asthma, many patients avoid exercise and physical activity because they are concerned about triggering asthma. In a sample of 258 asthma patients (mean age 42 years, 75% women), the objectives of this study were to assess the two-minute walk test and the repeated chair rise test and to compare results to self-reported physical activity recorded with the Paffenbarger Physical Activity and Exercise Index (PAEI). Patients walked a mean of 510 feet, required a mean of 14 seconds for the chair rise test, and reported a mean of 1,810 kilocalories per week from activities, mostly walking. In multivariable analysis, male sex, younger age, more education, lower body mass index, and better short-term asthma control, but not long-term asthma severity, were associated with better performance-based test results and more self-reported physical activity. Better short-term control also was associated with less breathing and leg exertion during both tests. Correlations between the PAEI and performance-based tests were approximately 0.38. Performance-based and self-reported measures provide information about various aspects of exercise capacity and can be used during routine clinical practice to assess physical activity in asthma patients.