Predicting children's quality of life in an asthma clinical trial: what do children's reports tell us?

OBJECTIVE: To define predictors of disease-specific quality of life (QOL) and the relationship between asthma symptoms and disease-specific QOL. STUDY DESIGN: Three hundred thirty-nine children participated at 4 of 8 Childhood Asthma Management Program clinical centers. Included in the analyses were 2 weeks of asthma symptom data, child-reported health status, and QOL scores from the Pediatric Asthma Quality of Life Questionnaire. Data were obtained 12 months after randomization into the Childhood Asthma Management Program. RESULTS: Children were rated at baseline as having "moderate" asthma (63%) and "mild" asthma (37%). QOL scores were correlated with the child-reported anxiety measures. Factor analysis of the QOL measure resulted in 2 factors. Stepwise multiple regression indicated that the strongest independent predictors of QOL were the child's anxiety level, age, sex, and a measure of the child's tendency to minimize or exaggerate symptoms. CONCLUSIONS: Children had few asthma symptoms in the 2 weeks before their 12-month follow-up clinic visit and a generally positive QOL, suggesting that mild-to-moderate asthma does not significantly impair QOL. A child's QOL was predicted primarily by their level of anxiety.

Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families. CAMP Research Group.

OBJECTIVE: To test the hypotheses that the burden of childhood asthma compromises psychological adaptation and that the degree of compromise increases with disease severity. DESIGN: The Childhood Asthma Management Program (CAMP) is a multicenter randomized clinical trial initiated and funded by the National Heart, Lung, and Blood Institute. SETTING: Study sites were located in Albuquerque, NM, Baltimore, Md, Boston, Mass, Denver, Colo, St Louis, Mo, San Diego, Calif, Seattle, Wash, and Toronto, Ontario. PARTICIPANTS: A total of 1,041 children aged 5 to 12 years were randomized to the trial after confirming their mild to moderate asthma. MAIN OUTCOME MEASURES: Psychological questionnaires administered at baseline to parents and participants assessed anxiety, depression, behavioral competence, social support, and family functioning. RESULTS: Psychological difficulty was not increased in this group of asthmatic children and their families. Psychological adaptation in the children was associated with the psychological adaptation of the family but not with disease-related variables. Scores from the Impact on Family Scale, a measure of family quality of life related to the child's illness, were associated more strongly with the overall psychological characteristics of the family and child and very little with disease characteristics or severity. CONCLUSIONS: Mild to moderate asthma has imposed modest effects on the daily life but not the psychological health of this group of children. Variation in the psychological characteristics of these children was, as is the case for most children, traceable to the overall psychological adaptation of their families.

Cognitive and behavioral findings in children taking theophylline.

In a prior pilot study involving six children, we noted improved memory and concentration and improved behavior when these children were switched from theophylline to cromolyn sodium therapy. We now report the findings in 29 children (24 boys and five girls), aged 7 to 12 years. In this study, a double-blind, double-dummy randomized design was used so that half the subjects continued to receive theophylline and the other half was actually switched from theophylline to cromolyn sodium therapy. Assessment again consisted of the revised Wechsler Intelligence Scale for Children, the Selective Reminding test, the Benton Visual Retention test, Stroop tests I and II, and the Child Behavior Checklist. The group receiving placebo theophylline/active cromolyn sodium therapy demonstrated greater improvement on all tests of memory and concentration, with greatest significance for the Stroop test (p less than 0.03 by analysis of covariance). There were also significant correlations between length of time theophylline was taken and scores on the depression (p less than 0.03) and the obsessive-compulsive (p less than 0.04) subscales of the Child Behavior Checklist. These results support the findings of the previous pilot study but, in addition, raise concern about depression and anxiety as possible long-term side effects of long-term theophylline therapy.