Chest
Volume 130, Issue 5, November 2006, Pages 1312-1318
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Original Research
The Influence of Perceived Control of Asthma on Health Outcomes

https://doi.org/10.1378/chest.130.5.1312Get rights and content

Background

Psychosocial factors play an important role in outcomes of asthma. Perceived control, a measure of patients' beliefs about their ability to control their disease, has not been studied in association with asthma health outcomes

Methods

We used data from a prospective cohort study of patients who were hospitalized for asthma (n = 865). After hospital discharge, we conducted structured telephone interviews to obtain demographic characteristics, asthma history, and psychological variables. Interviews included administration of the Perceived Control of Asthma Questionnaire (PCAQ). We then prospectively measured emergency department (ED) visits and hospitalizations for asthma over time, with a median follow-up time of 1.9 years

Results

Greater perceived control was associated with better physical health status (mean score increment per 2-point change in PCAQ score, 1.13; 95% confidence interval [CI], 0.79 to 1.47), better asthma-related quality of life (mean score increment, −2.24; 95% CI, −2.6 to −1.83), fewer days of restricted activity due to asthma (mean increment, −1.23; 95% CI, −1.62 to −0.83), and lower asthma severity scores (mean score increment, −0.40; 95% CI, −0.53 to −0.27). In a multivariate model, greater perceived control was associated with a significantly decreased prospective risk of ED visits (hazard ratio [HR], 0.92; 95% CI, 0.86 to 0.98; p = 0.008) and hospitalizations for asthma (HR, 0.84; 95% CI, 0.78 to 0.90; p < 0.0001). There was no association found between perceived control and most aspects of preventive care or self-management

Conclusions

Greater perceived control is associated with improved asthma-related health status as well as with a decreased prospective risk of severe asthma attacks resulting in emergency health-care utilization. This difference does not appear to be mediated by changes in preventive care or asthma self-management practices.

Section snippets

Overview

We used data from a prospective cohort study of adult members of an integrated health-care delivery system who were hospitalized for asthma during a 4-year period. After hospital discharge, we conducted structured telephone interviews that assessed asthma history, psychological variables, and health status. The goal was to elucidate the impact of perceived control of asthma on asthma health status and the longitudinal risk of emergency health-care utilization for asthma. The study was approved

Patient Characteristics

The baseline characteristics of the study population (n = 865) are summarized in Table 1. The mean age of the patients studied was 60 years; the majority were women, had completed at least some college, and were either current or former smokers. The mean perceived control of asthma score was 38 points (SD, 4.2 points; range, 18 to 55 points).

Correlation of Perceived Control With Asthma Severity and Health Status

Greater perceived control, as measured by a higher score on the PCAQ, was associated with better scores on the SF-12 for both mental health (r = 0.16; p <

Discussion

We found that, in a cohort of insured patients with asthma, greater perceived control is associated with improved measures of physical and mental health status, better quality of life, fewer depressive symptoms, and fewer days of restricted activity due to asthma. In addition, we found that greater perceived control is associated with a decreased prospective risk of ED visits and a decreased likelihood of hospitalization for asthma.

Our results expand on our previous findings by showing that

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      There is some indirect evidence that also a feeling of control over asthma symptoms may influence asthma symptom perception. For example, perceived control over asthma symptoms and its treatment (a construct related to self-efficacy) has been shown to improve quality of life and other health outcomes in persons with asthma [8,9]. Furthermore, the effect of (psycho)therapeutic interventions, asthma education, self-management programs, and breathing training on asthma symptoms – which typically improve asthma symptoms, in spite of the absence of improvement in pathophysiological indices – has been attributed to increased feelings of control [6,10,11].

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Dr. Eisner was supported by grant K23 HL04201 from the National Heart, Lung and Blood Institute, National Institutes of Health, with cofunding by the Social Security Administration.

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