Respirology (2004) 9, 87–95 Blackwell Science, LtdOxford, UKRESRespirology1323-77992004 Blackwell Science Asia Pty LtdMarch 2004918795Original Article HRQL in adults with asthmaRJ Adams et al. Correspondence: Robert J. Adams, Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville Road, Woodville SA 5011, Australia. Email: robert.adams@nwahs.sa.gov.au Professor Richard E. Ruffin took no part in the decision- making process with respect to this manuscript. Received 28 May 2002; revised 3 October 2003; accepted for publication 10 October 2003. ORIGINAL ARTICLE Impact of coping and socioeconomic factors on quality of life in adults with asthma Robert J. ADAMS, 1 David WILSON, 1 Brian J. SMITH 2 AND Richard E. RUFFIN 1 1 The Health Observatory, The University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia and 2 Respiratory Medicine Unit and Clinical Epidemiology and Health Outcomes Evaluation Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia Impact of coping and socioeconomic factors on quality of life in adults with asthma ADAMS RJ, WILSON D, SMITH BJ, RUFFIN RE. Respirology 2004; 9: 87–95 Objective: The socioeconomic variables of income, race and employment status have been shown to influence health-related quality of life (HRQL) scores in persons with asthma. However, little is known about the impact of other psychological factors or perceptions of economic hardship on HRQL in asthma, despite the known influence these have on general activity levels and emotional perceptions. The aim of the present study was to assess the relationships between psychological and socioeconomic factors and HRQL and on subsequent changes to HRQL over 12 months. Methodology: Consecutive adult patients with moderate or severe asthma attending outpatient clinics, emergency departments or who were inpatients at two teaching hospitals, completed surveys of clinical status, psychological and socioeconomic variables, and HRQL instruments (SF-36 and Modified Marks Asthma Quality of Life Questionnaire [MAQLQ-M]), at baseline and over 12-months follow-up. Results: Of 343 eligible subjects, survey responses were received from 293 at baseline and 232 at 12- months. Mean age was 42 years (SD 18), 67% were female, 42% had moderate, and 58% severe current asthma clinical status according to the National Asthma Education and Prevention Program guidelines criteria. In random-effects multiple regression models, after adjusting for age, gender, education, income and hospital, significant independent variables associated with each of total MAQLQ-M, SF-36 Physical Component Summary (PCS) and SF-36 Mental Component Summary (MCS) scores were avoidance coping, perceived recent financial difficulties and clinical asthma status. Additional independent associations were, for total MAQLQ-M, patient concerns about costs delaying them from seeking care (overall model r 2 = 0.69); for PCS, active coping (r 2 = 0.69) and for MCS, positive evaluations/satisfaction with illness (r 2 = 0.54). Conclusion: Psychological factors, particularly coping styles, need to be taken into account when considering HRQL scores as outcome measures in asthma. Interventions to improve the coping capabilities of individuals with moderate-to-severe asthma may be potentially important areas for improvement of asthma-related HRQL. Key words: asthma, coping, quality of life, socio-economic status. INTRODUCTION It has been advocated that measures of health status be used as primary outcome measures in clinical tri- als and to assess the effectiveness of healthcare orga- nizations in improving patient outcomes for people with asthma. 1,2 However, there are conceptual and technical difficulties in this approach, including a lack of detailed knowledge of how non-clinical factors influence HRQL scores. 3,4 Only weak or moderate associations have been found between HRQL and physiological measures, such as FEV 1 and bronchial hyperresponsiveness, indicating that other factors influence HRQL. 5,6 To the extent that psychosocial factors and the social environment influence the ability to perform roles and tasks, they will also affect HRQL scores. 7 Scores for instruments used in