Asthma in adolescents, during the transition from child to adult, effects on physiological parameters and health related quality of life

The aims of this thesis were to evaluate physiological and allergic
aspects and consequences of asthma and possible correlation between
Health Related Quality of Life (HRQOL) and atopy, lung function,
bronchial hyper-responsiveness and regular physical exercise. Possible
risk factors for deterioration among patients in their late teenage years
prior to and following transfer to adult healthcare were examined. The
study was designed to investigate possible differences between boys and
girls, changes over time in these respects and additionally the impact of
randomized referral to either a specialized asthma clinic or primary care
on the same factors.

In this prospective study, conducted at the asthma/allergy clinic of the
Childrens Hospital at Huddinge University 155 teenagers (69 females) with
asthma were followed over a five year period. The patients were recruited
consecutively and were screened employing spirometry, histamine challenge
(to investigate bronchial hyper-responsiveness), skin prick test for
allergy, and filled out  The Living With Asthma Questionnaire  both at
the time of entry into the study and after 2 and 5 years of follow-up. An
exercise test and questions about regular performed exercise were carried
out at baseline and 5 years later. Adolescents with mild-to-moderate
asthma were assigned randomly to care at the adult asthma clinic or
primary care.

When entering the study 89% were atopic. Lung-function increased from
94.0% of predicted (FEV1 mean value for the whole group (SD 12.9%) to
97.7% over the study period. Their Bronchial hyper-responsiveness
decreased (PD20 for histamine chloride was median 440µg at entrance and
increased five years later to 790µg) and working capacity decreased. At
all three time points HRQOL for the men was generally better than that of
the women. After five years HRQOL increased for both men and women but
still the men had better HRQOL at the total score (of the scale) compared
to the women. Young women who exercised regularly exhibited significant
better HRQOL than those who did not whereas regular exercise had no
impact on the HRQOL of the young men. Women with severe asthma
demonstrated a poorer HRQOL than those suffering from mild-to-moderate
asthma. Lung function, atopy, bronchial hyperresponsiveness did not exert
any impact on HRQOL. Poor adherence to asthma treatment was associated
with lower HRQOL as well as bronchial hyper-responsiveness. Adolescents
with mild-to-moderate asthma showed no difference in HRQOL regardless of
whether they received specialized treatment or primary care, lung
function, atopy or bronchial hyper-responsiveness.

Suffering from asthma during late adolescence was associated with lower
HRQOL for women than for men and this negative impact on adolescent women
was enhanced when asthmatic symptoms were more severe. The HRQOL of both
male and females improved as they grew older and entered adulthood. Lung
function improved but hyper-responsiveness persisted. Female gender and
poor adherence to asthma treatment exerted negative impact on
bronchialhyper responsiveness and HRQOL which emphasizes the importance
of health care programs that include patient education and support for
adolescents with asthma as they are transferred from pediatric to adult
health care. Mild-to-moderate asthma care can be equally handled in the
primary care system