The Prevalence and Patient’s Quality of Life for Asthma in Taiwan
Yung-hsiang Ying1, Yung-ching Weng2 and Koyin Chang3*
1National Taiwan Normal University, Taiwan
2Ming Chuan University, Taiwan
3Department of Healthcare Information and Management, Ming Chuan University, Taiwan
Submission: February 03, 2017; Published: March 23, 2017
*Corresponding author: Koyin Chang, Department of Healthcare Information and Management, Ming Chuan University, Taiwan, Email:firstname.lastname@example.org
How to cite this article: Yung-hsiang Y, Yung-ching W, Koyin C. The Prevalence and Patient’s Quality of Life for Asthma in Taiwan. Int J Pul & Res Sci. 2017; 1(2): 555560. DOI:10.19080/IJOPRS.2017.01.555560
Asthma affects approximately 5% of the population in Taiwan. The increasing prevalence has caused concerns for both general public and healthcare professionals. This study aims to understand patients’ quality of life in order to provide guidance for appropriate healthcare service as well as prevention. Face-to-face interview was conducted using Asthma Quality of Life Questionnaire (AQLQ) in a community hospital in northern Taiwan. A total of 106 questionnaires were collected. The results indicate that patients concern mostly about environmental stimuli which causes the greatest worries in the four functions of AQLQ. Middle aged patients have the worse quality of life than other age group counterparts. This is largely due to the emotional and physical stress as the result of the disease.
Asthma is a common chronic airway disease characterized by partially or completely reversible airway obstruction known as asthma attacks. The most common symptoms are coughing, dyspnea, and chest tightness. The adverse outcomes associated with asthma could lead to inability to work, hospitalization, disability, and morbidity. The disease places a heavy burden on governments, health care systems, patients, and their families. Worldwide estimates of the prevalence of adult asthma vary widely, from 0.8% to 13.4% . Ethnicity and demographic and environmental factors may contribute to these diverse variations. In Taiwan, the prevalence rate of Asthma is estimated to be 5.1%  for general population. The prevalence rate can be doubled for children. However, the severity of asthma increases after 18 years of age and the mortality is high in the elderly . The health care costs for hospital outpatient visits, urgent visits and hospitalization in adults with asthma are above 2 times of those without asthma . Though numerous studies have examined the epidemiology of asthma in Taiwan , studies of the patients’ quality of life are scant.
Thus, this study investigates patients’ health-related quality of life employing The Asthma Quality of Life Questionnaire (AQLQ) developed by Juniper et al.  to understand patients’ suffering from the disease.
Face-to-face interviews were conducted in a northern Taiwan community hospital. The inclusion criteria are 1. presence of symptoms of airflow obstruction (cough, wheezing, dyspnea), 2. Airflow obstruction is at least partially reversible (demonstrated by spiromentry at any time - FEV1 increased by >15% following β-agonist inhalation) or evidence of bronchial hyper responsiveness by metacholine challenge (demonstrated by PC20<8μg), 3. Age is 18 years or older. Patients’ obstructions involving large airways (such as foreign body in trachea or bronchus, vocal cord dysfunction, vascular rings or laryngeal webs, laryngotracheomalacia, tracheal stenosis or bronchostenosis, enlarged lymph nodes or tumor) or small airways (such as viral bronchiolitis or obliterative bronchiolitis, cystic fibrosis, bronchopulmonary dysplasia) and other causes such as drug induced symptoms or aspiration from swallowing mechanism dysfunction are excluded from the study.
There are 32 questions in the four domains (symptoms, activity limitation, emotional function and environmental stimuli) of AQLQ. The activity domain contains 5 ‘patient-specific’ questions. This allows patients to select 5 activities in which they are most limited and these activities will be assessed at each follow-up. Patients are asked to think about how they have been during the previous two weeks and to respond to
each of the 32 questions on a 7-point scale (7 = not impaired
at all, and 1 = severely impaired). The overall AQLQ score is the
mean of all 32 responses and the individual domain scores are
the means of the items in those domains. Thus, AQLQ has scores
range 1-7, with higher scores indicating better quality of life.
The validity of AQLQ was established by comparison to
conventional clinical asthma measures (symptoms, peak flow
rates, medication use, PFT, airway responsiveness, global rating
of asthma), generic HRQL measures (Rand; SIP)  clinical
sensibility of the measure ; symptoms & clinical efficacy .
The data collection period was from February 2013
to February 2014. All the patients were referred to the
interviewers by their physicians from the pulmonary clinics at
a local community hospital in Northern Taiwan. The physicians
explained the study purpose to the patients before referring them
to the interviewers. If the patients were not willing to accept
the interview then the physician would respect their decision.
This study was approved by the IRB board of the hospital.
Written informed consent was obtained from all participants
before conducting the interview. Patients who did not know
their diagnosis were not referred to us by their physician and
consequently were not recruited into this study interview.
To control the quality of the interviews, all researchinterviewers participated in a 2-3 h training program and received a detailed training document that delineated the study
purpose, language to be used, interview procedure and coding
Since the physicians explained the study purpose to the
patients before referring them to the interviewers, the response
rate of the study was fairly high. Around 123 patients were
invited to take part and 106 of them answered the questions.
Written informed consent was obtained from all participants
before conducting the interviews. Patients who did not know
their diagnosis were not referred to us by their physicians and
consequently were not recruited. Patients with very severe
symptoms would go to medical center for treatment. Thus this
study comprise the subject with not-so-severely ill asthma
patients at the time of interview.
The average age (±SD) of our subjects is 58.48 (±17.01) years
old with the oldest patient 85 years old and the youngest one
19 years of age. About 72% of the subjects are diagnosed with
asthma for less than 10 years and around 10% are diagnosed
with asthma from 10 to 20 years. 40.7% of the subjects are
cigarette smokers, and 24% of them received only primary
school education. 27% of the subjects reported to have severe
disease condition, 24% reported to be moderate condition, and
only 9% to be mild.
N: Number of subjects in the parentheses. Average quality of life in
the range of 1-7 for each function. Higher values represent better
quality of life. *, ** , and ***represent 10%, 5%, and 1%, respectively,
statistical significance in ANOVA analysis.
The results of QOL (quality of life) scores and the ANOVA
analysis across groups are reported in Table 1. Notably, the
age group of 30-39 and patients with disease year 11-20 have
the lowest overall QOL. Cigarette smoking behavior does not
affect patients’ overall QOL. But patients with cigarette smoking
behavior are lot more susceptible to environmental stimuli than
non-cigarette smokers, reflected by low QOL smokers.
Table 2 presents the relative importance for different
functions. Among the four functions, activity limitation received
the highest average score while environmental stimuli received
the lowest, indicating that environmental quality caused the
greatest concern for the patients. Patients are concerned about
cigarette smoke around them and would do their best to avoid it.
Though the function of activity limitation received a high score
for patients’ quality of life, the concern about the loss in activity
due to asthma is substantial, which received the lowest score in
An increasing prevalence rate of asthma in Taiwan has
drawn attention to general population as well as health
authority. Patients’ health-related quality of life is of concern
for both patients’ family and healthcare personnel for providing
better services. The result of this study indicates that patients
worry mostly about the environmental condition and stimuli
such as cigarette smoke that may cause uncomfortableness both
emotionally and physically. Patients in the middle age group has
the lowest QOL compared to younger and order counterparts.
This is probably because that the patients in this age group
takes main responsibility in the family and hence are under
great emotional stress about physical impairments. Activity
limitation is of less concern among the four functions in the AQLQ questionnaire. However, the worries and fear for further
impairments are the major reason for low QOL. This research
is done in a community hospital in norther Taiwan where not
the patients with most severe conditions go. An overestimate
of patients’ QOL is possible. Nonetheless, this paper provides
an overall understanding about how asthma patients might feel
in Taiwan. A good measure of environmental avoidance should
be propagandized in order to alleviate patients’ suffering both
emotionally and physically.