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Drug-related hospital admissions and responsiveness of health-related quality of life instruments in children with asthma Chow, Douglas Man Kam


Objective: To evaluate (1) the frequency of drug-related hospital admissions in Canadian children with asthma and (2) the responsiveness to clinical change of the Pediatric Health Related Quality of Life Questionnaire (PAQLQ) and a "patient-specific approach" to quality of life assessment in the children. Sample: Over 12-months, 54 of 61 patients admitted to one of the study hospitals for asthma or asthma-related symptoms participated in the study. Methodology: Data were gathered by personal interviews with patients, their families, and their health-care providers; reviews of patients' health record; and administration o f HRQOL instruments. Drug-related hospital admissions were evaluated by an expert panel using a set of objective criteria to- evaluate each case. The investigator administered HRQOL instruments to the patients during their hospital stay while they experienced acute asthma symptoms, and a second time six weeks after hospital discharge when patients were clinically improved. Results: 84% (95% CI = 73 - 95%) of 44 patients who participated in the drug-related hospital admission component of the study were deemed to have a "definite" relation between drug-intake and dose-related therapeutic failure (DTF), and 16% (95% CI = 5 - 27%) had a "possible" relation between drug intake and DTF. Evidence of inadequate treatment of chronic asthma was found in 43% of cases. Evidence of inadequate treatment of acute asthma was found in 95% of cases. If the presence of a respiratory tract infection were considered as a possible factor that could have explained patients' symptoms on hospital admission, then 52% (95% CI = 36 - 67%) of the 44 patients who participated in the drug-related hospital admission component of the study would have been deemed to have a "definite" relation between drug intake and DTF, and 48% (95% CI = 33 - 62%) would have been considered "possible" therapeutic failures. The PAQLQ was responsive to the change in clinical status that patients experienced when they were hospitalized compared to when they were well (ES = 1.5). The PAQLQ appeared more responsive than a patient-specific approach at assessing HRQOL domains in pediatric patients with asthma. Conclusion: Problems related to drug therapy may be a common factor in children admitted to hospital for asthma. Most children deemed to have a drug-related hospital admission were sub-therapeutic compared with the recommendations of the National Institutes of Health (NIH) National Heart Lung and Blood Institute Expert Panel Report II Guidelines, and the Canadian Asthma Consensus Conference Summary of Recommendations. The PAQLQ is a HRQOL instrument that has demonstrated responsiveness to changes in patients' clinical status. "Individualized" items did not improve the responsiveness of items in a questionnaire designed to assess HRQOL in children with asthma.

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