Methodological approaches to assessment and features of quality of life in children with bronchial asthma
https://doi.org/10.36604/1998-5029-2026-100-166-180
Abstract
The aim of the review is to analyze how physiological, psychological, and sociocultural factors influence the quality of life (QoL) in children with asthma. The review systematizes current data on methodological approaches to assessing health-related QoL in children with asthma, and provides a detailed overview of current tools, including general and specific questionnaires, emphasizing the importance of a comprehensive assessment of QoL in parents and caregivers. It discusses results from numerous studies, including randomized controlled trials that examine various aspects of QoL in children with asthma. The review highlights key factors that affect QoL. Special attention is given to psychological aspects of the disease during childhood and adolescence, which play a critical role in QoL formation. It is emphasized that negative psychological and sociocultural factors have a significant impact on QoL in children. Children with asthma are more likely to be obese or overweight and have poor sleep quality, tend to have poorer academic performance and lower socioeconomic status than healthy children. Unfavorable family and social relationships negatively influence disease control and QoL. The review identifies treatment adherence as a crucial factor for improving QoL. Enhancing adherence through educational programs and written management plans is vital for better disease control and overall QoL improvement.
About the Author
N. L. Perelman
Far Eastern Scientific Center of Physiology and Pathology of Respiration
Russian Federation
Russian Federation
Natalia L. Perelman, MD, PhD, DSc (Med.), Leading Staff Scientist, Laboratory of Molecular and Translational Research
22 Kalinina Str., Blagoveshchensk, 675000
References
1. WHO. WHOQOL: Measuring Quality of Life. Available at: https://www.who.int/tools/whoqol/whoqol-bref/
2. Perelman J.M., Perelman N.L., Kolosov V.P. [Quality of life in patients with asthma]. Vladivostok: Dal'nauka, 2024 (in Russian). ISBN: 978-5-8044-1738-4.
3. Belykh N.A., Piznyur I.V., Chernenko A.P., Anikeeva N.A., Deeva Yu.V. [The quality of life of parents of children with bronchial asthma]. Vestnik Avitsenny = Avicenna Bulletin 2025; 27(1):211–218 (in Russian). https://doi.org/10.25005/2074-0581-2025-27-1-211-218
4. García-Marcos L., Asher M.I., Pearce N., Ellwood E., Bissell K., Chiang C.Y., El Sony A., Ellwood P., Marks G.B., Mortimer K., Martínez-Torres A.E., Morales E., Perez-Fernandez V., Robertson S., Rutter C.E., Silverwood R.J., Strachan D.P. The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study. Eur. Respir. J. 2022; 60(3):2102866. https://doi.org/10.1183/13993003.02866-2021
5. Fleming M., Fitton C.A., Steiner M.F.C., McLay J.S., Clark D., King A., Mackay D.F., Pell J.P. Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683 716 children. Eur. Respir. J. 2019; 54(3):1802309. https://doi.org/10.1183/13993003.02309-2018
6. Gandhi P.K., Kenzik K.M., Thompson L.A., DeWalt D.A., Revicki D.A., Shenkman E.A., Huang I.C. Exploring factors influencing asthma control and asthma-specific health-related quality of life among children. Respir. Res. 2013; 14(1):26. https://doi.org/10.1186/1465-9921-14-26
7. Papadopoulos N.G., Custovic A., Deschildre A., Gern J.E., Nieto Garcia A., Miligkos M., Phipatanakul W., Wong G., Xepapadaki P., Agache I., Arasi S., Awad El-Sayed Z., Bacharier L.B., Bonini M., Braido F., Caimmi D., Castro-Rodriguez J.A., Chen Z., Clausen M., Craig T., Diamant Z., Ducharme F.M., Ebisawa M., Eigenmann P., Feleszko W., Fierro V., Fiocchi A., Garcia-Marcos L., Goh A., Gómez R.M., Gotua M., Hamelmann E., Hedlin G., Hossny E.M., Ispayeva Z., Jackson D.J., Jartti T., Jeseňák M., Kalayci O., Kaplan A., Konradsen J.R., Kuna P., Lau S., Le Souef P., Lemanske R.F., Levin M., Makela M.J., Mathioudakis A.G., Mazulov O., Morais-Almeida M., Murray C., Nagaraju K., Novak Z., Pawankar R., Pijnenburg M.W., Pite H., Pitrez P.M., Pohunek P., Price D., Priftanji A., Ramiconi V., Rivero Yeverino D., Roberts G., Sheikh A., Shen K.L., Szepfalusi Z., Tsiligianni I., Turkalj M., Turner S., Umanets T., Valiulis A., Vijveberg S., Wang J.Y., Winders T., Yon D.K., Yusuf O.M., Zar H.J.; WAO Pediatric Asthma Committee. Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO. Pediatr. Allergy Immunol. 2024; 35(4):e14129. https://doi.org/10.1111/pai.14129
8. Varni J.W., Seid M., Kurtin P.S. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med. Care 2001; 39(8):800–812. https://doi.org/10.1097/00005650-200108000-00006
9. Lewis C.C., Pantell R.H., Kieckhefer G.M. Assessment of children's health status. Field test of new approaches. Med. Care 1989; 27(Suppl.3):S54–S65. https://doi.org/10.1097/00005650-198903001-00005
10. Juniper E.F., Guyatt G.H., Feeny D.H., Ferrie P.J., Griffith L.E., Townsend M. Measuring quality of life in children with asthma. Qual. Life Res. 1996; 5:35–46. https://doi.org/10.1007/BF00435967
11. Juniper E.F. Paediatric Asthma Quality of Life Questionnaire (PAQLQ). Available at: https://eprovide.mapi-trust.org/instruments/paediatricasthma-quality-of-life-questionnaire
12. Rosier M.J., Bishop J., Nolan T., Robertson C.F., Carlin J.B., Phelan P.D. Measurement of functional severity of asthma in children. Am. J. Respir. Crit. Care Med. 1994; 149(6):1434–1441. https://doi.org/10.1164/ajrccm.149.6.8004295
13. Silva N., Carona C., Crespo C., Canavarro M.C. Quality of life in pediatric asthma patients and their parents: a metaanalysis on 20 years of research. Expert. Rev. Pharmacoecon. Outcomes Res. 2015; 15(3):499–519. https://doi.org/10.1586/14737167.2015.1008459
14. Roncada C., Dias C.P., Goecks S., Cidade S.E., Pitrez P.M. [Usefulness of the WHOQOL-BREF questionnaire in assessing the quality of life of parents of children with asthma]. Rev. Paul. Pediatr. 2015; 33(3):268–274 (in Portuguese). https://doi.org/10.1016/j.rpped.2015.01.007
15. Roncada C., Medeiros T.M., Strassburger M.J., Strassburger S.Z., Pitrez P.M. Comparison between the health-related quality of life of children/adolescents with asthma and that of their caregivers: a systematic review and meta-analysis. J. Bras. Pneumol. 2020; 46(3):e20190095. https://doi.org/10.36416/1806-3756/e20190095
16. Juniper E.F., Guyatt G.H., Feeny D.H., Ferrie P.J., Griffith L.E., Townsend M. Measuring quality of life in the parents of children with asthma. Qual. Life Res. 1996; 5(1):27–34. https://doi.org/10.1007/BF00435966
17. Bursch B., Schwankovsky L., Gilbert J., Zeiger R.. Construction and validation of four childhood asthma self-management scales: parent barriers, child and parent self-efficacy, and parent belief in treatment efficacy. J. Asthma 1999; 36(1):115–128. https://doi.org/10.3109/02770909909065155
18. Kan K., Fierstein J., Boon K., Kanaley M., Zavos P., Volerman A., Vojta D., Gupta R.S. Parental quality of life and selfefficacy in pediatric asthma. J. Asthma 2021; 58(6):742–749. https://doi.org/10.1080/02770903.2020.1731825
19. Indinnimeo L., Chiarotti F., De Vittori V., Baldini L., De Castro G., Zicari A.M., Tancredi G., Leonardi L., Duse M. Risk factors affecting quality of life in a group of Italian children with asthma. Int. J. Immunopathol. Pharmacol. 2014; 27(2):235– 244. https://doi.org/10.1177/039463201402700210
20. Basso R.P., Jamami M., Labadessa I.G., Regueiro E.M., Pessoa B.V., Oliveira A.D. Jr, Di Lorenzo V.A., Costa D. Relationship between exercise capacity and quality of life in adolescents with asthma. J. Bras. Pneumol. 2013; 39(2):121–127. https://doi.org/10.1590/s1806-37132013000200002
21. Shi M., Liang L., Wang Y., Yu Y. Risk factors associated with health-related quality of life in pediatric asthma. Sci. Prog. 2021; 104(2):368504211013657. https://doi.org/10.1177/00368504211013657
22. Kasse T., Zenebe S., Agegnehu Y., Lonsako A.A. Factors influencing health-related quality of life in children with asthma: insights from Addis Ababa public hospitals. Front. Public Health 2025; 12:1478707. https://doi.org/10.3389/fpubh.2024.1478707
23. Kansen H.M., Le T.M., Meijer Y., Uiterwaal C.S.P.M., Knulst A.C., van der Ent C.K., van Erp F.C. Perceived triggers of asthma impair quality of life in children with asthma. Clin. Exp. Allergy 2019; 49(7):980–989. https://doi.org/10.1111/cea.13407.
24. Raymond K.P., Fiese B.H., Winter M.A., Knestel A., Everhart R.S. Helpful hints: caregiver-generated asthma management strategies and their relation to pediatric asthma symptoms and quality of life. J. Pediatr. Psychol. 2012; 37(4):414–423. https://doi.org/10.1093/jpepsy/jss001
25. Plaza-González S., Zabala-Baños M.D.C., Astasio-Picado Á., Jurado-Palomo J. Psychological and sociocultural determinants in childhood asthma disease: impact on quality of life. Int. J. Environ. Res. Public Health 2022; 19(5): 2652. https://doi.org/10.3390/ijerph19052652
26. Agnafors S., Norman Kjellström A., Torgerson J., Rusner M. Somatic comorbidity in children and adolescents with psychiatric disorders. Eur. Child. Adolesc. Psychiatry 2019; 28(11):1517–1525. https://doi.org/10.1007/s00787-019-01313-9
27. Edvinsson Sollander S., Fabian H., Sarkadi A., Salari R., Fält E., Dahlberg A., Feldman I., Durbeej N. Asthma and allergies correlate with mental health problems in preschool children. Acta Paediatr. 2021; 110(5):1601–1609. https://doi.org/10.1111/apa.15709
28. Mohamed S.O.O., Ahmed M.M.I., Elawad I. Burden and factors associated with depression and anxiety disorders in pediatric asthma: a cross-sectional study. Avicenna J. Med. 2025; 15(4):165–169. https://doi.org/10.1055/s-0045-1814096
29. Annett R.D., Bender B.G., Lapidus J., Duhamel T.R., Lincoln A. Predicting children's quality of life in an asthma clinical trial: what do children's reports tell us? J. Pediatr. 2001; 139(6):854–861. https://doi.org/10.1067/mpd.2001.119444
30. Zhang B., Hou W., Duan Y. Influencing factors of quality of life in asthma children. Chinese J. Child Health Care 2023; 31(12):1359–1364. https://doi.org/10.11852/zgetbjzz2023-0777
31. Nitya U.S., Sreenivasan V., Gulvadi A.A., Lukose R. Assessment of health-related quality of life in children with bronchial asthma and their caregivers at a teaching institution: a cross-sectional study. J. Family Med. Prim. Care 2025; 14(7):2831–2836. https://doi.org/10.4103/jfmpc.jfmpc_1832_24
32. Stridsman C., Backman H., Eklund B.M., Rönmark E., Hedman L. Adolescent girls with asthma have worse asthma control and health-related quality of life than boys - a population based study. Pediatr. Pulmonol. 2017; 52(7):866–872. https://doi.org/10.1002/ppul.23723
33. Sundell K., Bergström S.E., Hedlin G., Ygge B.M., Tunsäter A. Quality of life in adolescents with asthma, during the transition period from child to adult. Clin. Respir J. 2011; 5(4):195–202. ttps://doi.org/10.1111/j.1752-699X.2010.00218.x
34. Kouzegaran S., Samimi P., Ahanchian H., Khoshkhui M., Behmanesh F. Quality of life in children with asthma versus healthy children. Open Access Maced. J. Med. Sci. 2018; 6(8):1413–1418. https://doi.org/10.3889/oamjms.2018.287
35. Daniel L.C., Boergers J., Kopel S.J., Koinis-Mitchell D. Missed sleep and asthma morbidity in urban children. Ann. Allergy Asthma Immunol. 2012; 109(1):41–46. https://doi.org/10.1016/j.anai.2012.05.015
36. Strang A.R., Covington L., Rani S., Gao D., Flores M., Canter K., Patterson F., Chidekel A. Daytime sleepiness in children with asthma: examining respiratory and non-respiratory factors. Cureus 2023; 15(6):e40370. https://doi.org/10.7759/cureus.40370
37. Meltzer L.J., Ullrich M., Szefler S.J. Sleep duration, sleep hygiene, and insomnia in adolescents with asthma. J. Allergy Clin. Immunol. Pract. 2014; 2(5):562–569. https://doi.org/10.1016/j.jaip.2014.02.005
38. Meltzer L.J., Beebe D.W., Jump S., Flewelling K., Sundström D., White M., Zeitlin P.L., Strand M.J. Impact of sleep opportunity on asthma outcomes in adolescents. Sleep Med. 2020; 65:134–141. https://doi.org/10.1016/j.sleep.2019.07.014
39. Mølbæk-Engbjerg T., Vahman N., Ali M., Skov F., Vinding R., Horner D., Brustad N., Thorsen J., Schoos A.M., Stokholm J., Bønnelykke K., Chawes B. Risk behaviours and non-atopic comorbidities of adolescents with asthma. World Allergy Organ J. 2025; 18(8):101093. https://doi.org/10.1016/j.waojou.2025.101093
40. Fedele D.A., Janicke D.M., Lim C.S., Abu-Hasan M. An examination of comorbid asthma and obesity: assessing differences in physical activity, sleep duration, health-related quality of life and parental distress. J. Asthma 2014; 51(3):275–281. https://doi.org/10.3109/02770903.2013.873807
41. Sampaio F., Ssegonja R., Nystrand C., Feldman I. Health, public sector service use and related costs of Swedish preschool children: results from the children and parents in focus trial. Eur. Child. Adolesc. Psychiatry 2019; 28(1):43–56. https://doi.org/10.1007/s00787-018-1185-1
42. Butler A., Van Lieshout R.J., Lipman E.L., MacMillan H.L., Gonzalez A., Gorter J.W., Georgiades K., Speechley K.N., Boyle M.H., Ferro M.A. Mental disorder in children with physical conditions: a pilot study. BMJ Open 2018; 8(1):e019011. https://doi.org/10.1136/bmjopen-2017-019011
43. Paracha R., Lo D.K.H., Montgomery U., Ryan L., Varakantam V., Gaillard E.A. Asthma medication adherence and exacerbations and lung function in children managed in Leicester primary care. NPJ Prim. Care Respir. Med. 2023; 33(1):12. https://doi.org/10.1038/s41533-022-00323-6
44. Klok T., Kaptein A.A., Duiverman E.J., Brand P.L. Long-term adherence to inhaled corticosteroids in children with asthma: observational study. Respir. Med. 2015; 109(9):1114–1119. https://doi.org/10.1016/j.rmed.2015.07.016
45. Alshehri A.M., Almogbel Y.S., Alsahali S.M., Alosaily Y.A., Almohaimeed G.M., Alotayk L.I., Alqunaisy A.A. Factors associated with asthma medication adherence in parents with asthmatic children: theory of planned behavior. Healthcare (Basel) 2025; 13(13):1613. https://doi.org/10.3390/healthcare13131613
46. Broquet Ducret C., Verga M.E., Stoky-Hess A., Verga J., Gehri M. [Impact of a small-group educational intervention for 4- to 12-year-old asthmatic children and their parents on the number of healthcare visits and quality of life]. Arch. Pediatr. 2013; 20(11):1201–1205 (in French). https://doi.org/10.1016/j.arcped.2013.08.021.
47. Larsen K., Zhu J., Feldman L.Y., Simatovic J., Dell S., Gershon A.S., To T. The annual September peak in asthma exacerbation rates. Still a reality? Ann. Am. Thorac. Soc. 2016; 13(2):231–239. https://doi.org/10.1513/AnnalsATS.201508-545OC
48. Chan A.H., Stewart A.W., Foster J.M., Mitchell E.A., Camargo C.A.Jr, Harrison J. Factors associated with medication adherence in school-aged children with asthma. ERJ Open Res. 2016; 2(1):00087-2015. https://doi.org/10.1183/23120541.00087-2015
49. Rhee H., Wicks M.N., Dolgoff J.S., Love T.M., Harrington D. Cognitive factors predict medication adherence and asthma control in urban adolescents with asthma. Patient Prefer. Adherence 2018; 12:929–937. https://doi.org/10.2147/PPA.S162925
50. Harris K., Kneale D., Lasserson T.J., McDonald V.M., Grigg J., Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst. Rev. 2019; 1(1):CD011651. https://doi.org/10.1002/14651858.CD011651.pub2
51. Pearce C.J., Chan A.H.Y., Jackson T., Fleming L., Foot H., Bush A., Horne R. Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: a narrative systematic review. Pediatr. Pulmonol. 2022; 57(4):822–847. https://doi.org/10.1002/ppul.25838
52. Chongmelaxme B., Lee S., Dhippayom T., Saokaew S., Chaiyakunapruk N., Dilokthornsakul P. The effects of telemedicine on asthma control and patients' quality of life in adults: a systematic review and meta-analysis. J. Allergy Clin. Immunol. Pract. 2019; 7(1):199–216. https://doi.org/10.1016/j.jaip.2018.07.015
53. Snoswell C.L., Rahja M., Lalor A.F. A systematic review and meta-analysis of change in health-related quality of life for interactive telehealth interventions for patients with asthma. Value Health 2021; 24(2):291–302. https://doi.org/10.1016/j.jval.2020.09.006
54. Suvarna K.C., Kumar P., Singh K., Kumar J., Goyal J.P. Comparison of telemedicine versus in-person visit for control of asthma in children aged 7-17 years: a randomized controlled trial. Indian J. Pediatr. 2025; 92(5):467–473. https://doi.org/10.1007/s12098-024-05028-x
55. Muhammad J., Ngah N.D., Ahmad I. Written asthma action plan improves asthma control and the quality of life among pediatric asthma patients in Malaysia: a randomized control trial. Korean J. Fam. Med. 2023; 44(1):44–52. https://doi.org/10.4082/kjfm.22.0016
56. Rochester C.L., Alison J.A., Carlin B., Jenkins A.R., Cox N.S., Bauldoff G., Bhatt S.P., Bourbeau J., Burtin C., Camp P.G., Cascino T.M., Dorney Koppel G.A., Garvey C., Goldstein R., Harris D., Houchen-Wolloff L., Limberg T., Lindenauer P.K., Moy M.L., Ryerson C.J., Singh S.J., Steiner M., Tappan R.S., Yohannes A.M., Holland A.E. Pulmonary rehabilitation for adults with chronic respiratory disease: An official American Thoracic Society clinical practice guideline. Am. J. Respir. Crit. Care Med. 2023; 208(4):e7–e26. https://doi.org/10.1164/rccm.202306-1066ST
57. Basaran S., Guler-Uysal F., Ergen N., Seydaoglu G., Bingol-Karakoç G., Ufuk Altintas D. Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma. J. Rehabil. Med. 2006; 38(2):130–135. https://doi.org/10.1080/16501970500476142
58. Zhou L., Xu H. Feasibility of exercise therapy for children with asthma: a meta-analysis. Front. Cell Dev. Biol. 2023; 11:1192929. https://doi.org/10.3389/fcell.2023.1192929
59. Mokina N.A., Ivanova V.N. [Gender and age influence on the quality of life in children with bronchial asthma for the sanatorium treatment]. Mediko-farmatsevticheskiy zhurnal «PUL'S» = Medical & pharmaceutical journal «PULSE» 2023; 25(1):132–135 (in Russian). https://doi.org/10.26787/nydha-2686-6838-2023-25-1-132-135
60. Latorre-Román P.Á., Navarro-Martínez A.V., García-Pinillos F. The effectiveness of an indoor intermittent training program for improving lung function, physical capacity, body composition and quality of life in children with asthma. J. Asthma 2014; 51(5):544–551. https://doi.org/10.3109/02770903.2014.888573
61. Yourell J., Koskela-Staples N., Doty J., Fedele D.A. Risk and protective factors for physical activity engagement among adolescents with comorbid asthma and obesity. J. Pediatr. Psychol. 2023; 48(1):39–50. https://doi.org/10.1093/jpepsy/jsac061
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Perelman N.L. Methodological approaches to assessment and features of quality of life in children with bronchial asthma. Bulletin Physiology and Pathology of Respiration. 2026;(100):166-180. (In Russ.) https://doi.org/10.36604/1998-5029-2026-100-166-180
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