An Assessment of Quality of Life in Libyan Patients with Bronchial Asthma: A Clinical Benefit in Using Most Desirable Inhaler Techniques

Abstract

Inhaled drug therapy remains the treatment option of choice for majority of patients with asthma. Asthma is a major chronic inflammatory disease of the respiratory tract. This study is designed to evaluate if the use of 2Tone helps patients maintain the correct inhalation technique after training and can improve their quality of life using AQLQ (Asthma quality of life questionnaire) and JMI (Jones morbidity index) questionnaires. AQLQ is a disease-specific health related quality of life tool which has good measurement properties and valid as an evaluative and a discriminative instrument. JMI is used as a simple and practical tool for asthma evaluation morbidity. 125 Libyan asthmatic patients from respiratory department outpatient of medical center (Tripoli) were included. Patients were divided into two groups; intervention and control. The intervention group was divided into those who were verbally trained about the MDI inhalation flow rate technique named verbal group (VT) and those called the 2Tone group (2T). Patients in the 2T group received the same verbal training as the VT group and were given 2Tone Trainer. The second visit for all patients was held six weeks later and each patient was assessed in the same manner as on the first visit. The patient was asked to fill in a self-administered AQLQ and answer questions from JMI. All patients in control group at both visits were inhaling at flow rate < 90 L/min with mean IFR of 66 L/min. Patients mean IFR in VT and 2T groups were less than 90 L/min at visit 2. Comparison of patient’s total AQLQ scores between visits shows no patients in group control group recorded statistical difference. In contrast, 17 patients (48.6%) in VT group and 30 patients (83.3%) in the 2T group recorded significant difference in AQLQ score between visits. Comparisons in morbidity between groups at visits shown that about half of patients in 2T group and 20% of patients in VT group were reduced in the severity category after counselling whereas in control group. There was almost no statistical different between visits. No difference between the patient’s perceptions of symptom control at visit 1 between the groups was observed but a significant difference at visit 2 was noted. Comparison between visits within each group showed that in 2T group patients’ perception of their asthma symptoms improved but did not change in the other two groups. A correlation was very strong between juniper questionnaire and JMI as studied by counselling group with significant association. This study shows that a high correlation between juniper questionnaire and JMI by counselling. This may be a reflection to use JMI as a quick tool to evaluate asthmatic patients to save time and increase patient compliance.