الفهرس 
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Abstract
The quality of life of children and adolescents with asthma deserve special attention, because asthma affects not only the individuals with the disease, but also their caregivers, thereby altering the family’s normal life activities. Different questionnaires have been developed to assess health related quality of life (HRQoL). EQ-5D-Y is a generic instrument, based on the EQ-5D adult version, which provides the opportunity to address a child’s HRQoL, regardless of the disease.
We sought to assess the HRQoL of asthmatic children in relation to their asthma severity and control, using the EQ-5D-Y questionnaire, in comparison to matched controls. We conducted a cross-sectional which included 3 groups of subjects: bronchial asthma group (n=100), aged 6-12 years, infection group (n=114), and healthy control group (n=100) with comparable age and gender distribution. Subjects were consecutively enrolled from the Pediatric Allergy and Immunology Unit, (asthmatic group), and Outpatient Clinic (control groups), Children’s Hospital, Ain Shams University during the period from April 2018 and May 2019. Subjects with chronic illnesses or significant medical and/or social problems unrelated to asthma were excluded from the study.
Enrolled subjects were evaluated with detailed history taking and clinical examination. Asthma severity and control were assessed according to the GINA, 2018. Dimensions of the EQ-5D-Y questionnaire were asked and interpreted by the researcher during interview of the child in the presence of the caregiver. The questionnaire also included a visual analogue scale (VAS), with scores ranging from 0-100.
The collected data revealed that, 86% of asthmatics faced problems with their daily activities (74% of them had some problems and 12% had a lot of problems). Moreover, the children suffered emotionally, 31% of them had some worries, sadness and unhappiness, while 12% had a lot of emotional problems. Also, mobility was adversely affected in the asthma group; 22% had some problems walking about. On the contrary, the self-care did not represent a significant problem (6%). Thirteen percent of the cases expressed some pain or discomfort due to their disease. The study reveals that, asthmatics’ VAS scores ranged from 10 to 100 with mean value of 72.2 ± 24.6 SD, which was the lowest figure in the three studied groups.
The most commonly affected dimension in the asthmatic group were “doing usual activities”, “feeling worried, sad or unhappy” and “mobility”. The main affected dimensions in the infection group, were doing usual activities (83.3% had some problems and 4.4% had a lot of problems) and having pain or discomfort (71.1% had some problems and 10.5% had a lot of problems). In the healthy control group, half of them had some pain or discomfort and 48% of them had some problems with doing their usual activities.
Mobility had weak direct correlation with age (p= .001), disease duration (p= .041), asthma control (p= .001) and LABA (p= .005), and moderate direct correlation with VAS score (p= <.001). Usual activities revealed a strong direct correlation with VAS score (p= <.001) and moderate correlation with asthma control (p=<.001). Having pain or discomfort showed a strong direct correlation with the VAS score (p= <.001). Feeling worried, sad or unhappy correlated positively with VAS score (p= <.001), age (p= <.001), disease duration (p= <.001) and asthma control (p= <.001).
In conclusion, the study denotes that bronchial asthma has a significant adverse impact on HRQoL of asthmatic children and that EQ-5D-Y questionnaire could be a valuable instrument to measure the quality of life in asthmatic children. The asthmatic children experienced problems mainly in the dimensions relating to ‘doing usual activities’, ‘having pain or discomfort’, ‘feeling worried, sad or unhappy’, and ’mobility’. The findings are indeed limited by the sample size and cross sectional design. The consecutive manner of enrollment did not allow for even distribution of the sample according to severity and level of control.
We recommend inclusion of asthma related QoL and to psychosocial screening in the routine pediatric asthma care, aiming to improve asthma control and management. Further prospective wider-scale studies are needed to confirm our conclusions. Translation and validation of the EQ-5D-Y questionnaire into the Arabic language is also needed to be more feasible and to avoid bias during the interpretation of the questions