Background In recent decades, asthma‐related quality of life questionnaires have joined objective clinical indicators as important outcome measures. In this study, we sought to investigate the predictors of asthma‐related quality of life in a large cohort of patients recruited from a secondary care center. Methods We conducted a cross‐sectional study on asthmatics ( N = 1301) recruited from the Liège University Hospital asthma clinic (Belgium). After performing a descriptive analysis highlighting the distribution of scores from the Mini Asthma Quality of Life Questionnaire (Mini AQLQ) and its four dimensions (symptoms, activity limitation, emotional function, and environmental stimuli), we did multiple regression analysis to identify the independent predictors of AQLQ. Results Multiple regression beta analysis showed that AQLQ and its four dimensions were primarily associated with asthma control ( p < 0.0001 in all instances). Female gender was associated with a lower score for the AQLQ's activity and environmental dimensions ( p < 0.05 for both), while current smokers had a higher score on the AQLQ's environmental dimension ( p < 0.0001). The burden of asthma treatment was associated with a lower score for the AQLQ's emotional ( p < 0.05) and environmental ( p < 0.05) dimensions. BMI was associated with a lower score in the AQLQ's activity dimension ( p < 0.0001), while the opposite was true for the FeNO test ( p < 0.0001). Sputum neutrophils were inversely related to the score for the AQLQ's symptom dimension ( p < 0.05), whereas post‐bronchodilator FEV 1 showed a positive relationship for that same dimension ( p < 0.05). Conclusion Asthma control is the main predictor of AQLQ score and impacts all its dimensions, but demographic, functional, and airway inflammatory parameters may also influence some dimensions of the AQLQ.

Chronic obstructive pulmonary disease (COPD) is a complex, multidimensional and heterogeneous disease. The main purpose of the present study was to identify clinical phenotypes through cluster analysis in adults suffering from COPD. A retrospective study was conducted on 178 COPD patients in stable state recruited from ambulatory care at University hospital of Liege. All patients were above 40 years, had a smoking history of more than 20 pack years, post bronchodilator FEV1/FVC <70% and denied any history of asthma before 40 years. In this study, the patients were described by a total of 84 mixed sets of variables with some missing values. Hierarchical clustering on principal components (HCPC) was applied on multiple imputation. In the final step, patients were classified into homogeneous distinct groups by consensus clustering. Three different clusters, which shared similar smoking history were found. Cluster 1 included men with moderate airway obstruction (n ¼ 67) while cluster 2 comprised men who were exacerbation-prone, with severe airflow limitation and intense granulocytic airway and neutrophilic systemic inflammation (n ¼ 56). Cluster 3 essentially included women with moderate airway obstruction (n ¼ 55). All clusters had a low rate of bacterial colonization (5%), a low median FeNO value (<20 ppb) and a very low sensitization rate toward common aeroallergens (0-5%). CAT score did not differ between clusters. Including markers of systemic airway inflammation and atopy and applying a comprehensive cluster analysis we provide here evidence for 3 clusters markedly shaped by sex, airway obstruction and neutrophilic inflammation but not by symptoms and T2 biomarkers.

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Asthma negatively impacts health-related quality of life (HRQL). Many cross-sectional studies have already explored the factors associated with HRQL in asthma. To the best of our knowledge, no real life studies have investigated the longitudinal relationship between HRQL in asthma and disease control, demographic and clinical objective parameters in an adult population. METHODS: We conducted a longitudinal study on asthmatics recruited from Liege University Hospital Asthma Clinic (Belgium) between 2011 and 2019. We selected those who were ≥18 years old at visit one, had two visits, and completed each time two patient-reported outcome measures (PROMs), the asthma control test (ACT) and the mini asthma quality of life questionnaire (AQLQ) (N=290). AQLQ and its dimensions (symptoms, activity, emotional and environmental dimensions) were the dependent variables. Demographic, functional and inflammatory (blood and sputum) characteristics, asthma control and exacerbations were the independent variables. We applied a multivariate regression mixed model (MRMM) to identify the factors associated with change in AQLQ and its dimensions. In addition, we also performed multivariate logistic regression mixed model (MLRMM) to identify the factors associated with reaching an optimal quality of life (AQLQ ≥6). RESULTS: Median (IQR) time interval between the two visits was 7 (5-19) months. Median (IQR) global AQLQ increased from 4.1 (3-5.1) to 4.6 (3.4-5.9) with significant improvement in all dimensions (p <0,0001) but the environmental one. AQLQ improved irrespective of any treatment change. The proportion of patients with global optimal AQLQ (≥6) raised from 8 % at visit-1 to 22% at visit-2.MRMM indicated that change in ACT was the main determinant of change in global AQLQ and all its dimensions (p <0,0001 for all). Change in BMI inversely impacted global AQLQ (p <0,01) and its activity dimension (p <0,0001). MLRMM model found that rise in ACT significantly increase the probability of achieving optimal global AQLQ and its four dimensions (OR = 1.92 for global, p <0.0001; OR = 1.68 for symptoms, p <0.0001; OR = 1.56 for activity, p <0.0001; OR = 1.45 for emotional, <0.0001; OR = 1.20 for environmental, p <0.0001). Moreover, optimal AQLQ in the activity dimension was inversely related to change in BMI (OR =0,87; p <0.01) and positively associated with change in fractional exhaled nitric oxide (FeNO) (OR =1,012; p <0.01). CONCLUSIONS: Asthma control is the main determinant of change in asthma quality of life, but BMI and FeNO may significantly impact the activity dimension in an opposite direction.

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