Lebensqualität, Angst und Depression bei Asthma bronchiale und chronisch obstruktiver Lungenerkrankung (COPD): Patienten- und Angehörigenperspektive

ABSTRACT Asthma and chronic obstructive pulmonary disease (COPD) are widespread diseases in Germany. Nine to 14 percent of children and adolescents suffer from asthma, this being the most frequent and chronic disease of children and adolescents in Germany. At present, prevalence rates for asthma that increased over the last four decades seem to have stabilised. But already more than 9% of adults older than 40 years of age suffer from COPD, and prevalence rates are still expected to increase further. Differences and similarities of asthma and COPD are to be described briefly. Both disorders reduce functioning in different areas of life. Maintenance and improvement of disease specific quality of life in patients with asthma and COPD is a major goal for healthcare. Treatment and coping with both disorders require a great deal of psychosocial adaptation from patients and relatives. In the first article, data relating to these issues are presented. To improve standardized data collection, two questionnaires tapping quality of life in patients with asthma and COPD have been developed for this cumulative dissertation. The first one „Fragebogen zur asthmabezogenen Lebensqualität bei Kindern“ - FALK (Children’s Questionnaire for Asthma-Related Quality of Life - CQAQL) is a self-rating questionnaire on health related quality of life for children. It was evaluated in a sample of 119 children and adolescents. The thirty items of the questionnaire yielded the following three scales: subjective distress, fear of medical interventions and asthma related anxiety, and subjective health, reflecting psychosocial impairment and subjective health in general. In a second investigation, psychometric qualities of the COPD-Disability-Index (CDI) were studied to identify impairment caused by the disease. One hundred and forty-three stable COPD outpatients with a severity grade between 2 and 4 (according to the GOLD criteria) as well as 105 spouses took part in the study. The internal consistency of the self- and observer-rating-questionnaires for this seven item questionnaire is very high with alpha .90. Good convergent and divergent validity is confirmed with high and low correlations between construct-related and unrelated questionnaires, respectively (e.g., the St. George’s Respiratory Questionnaire (r = .83). This study confirms hightend anxiety and affective disorder prevalence rates in patients with COPD, in comparison to a representative German sample. Those prevelance rates are also heightend in their relatives. Predictors of COPD-specific quality of life in patients and spouses were also studied. Confirming existing studies, depression, walking distance, somatization, male gender, forced expiratory volume in 1 second expressed in percentage predicted (FEV1%), and heart disease proved to be significant predictors for quality of life in patients. When entering relative predictors into this regression analysis, relative anxiousness significantly predicts quality of life in patients, but FEV1% and heart disease are excluded from the analysis. This psychosocial impairment of spouses of patients with COPD, i.e. the influence of their anxiousness on patients quality of life should receive further attention in future studies. Implications of results will be discussed.