Faced with chronic or long-standing diseases such as asthma the physician must not only prescribe the correct treatment and see that the patient complies with perfectly but must also be watchful for any deterioration in the patient's daily activities, whether occupational, scholastic, social or sporting. This has always been one of the physician's concerns although these have kept pace with the passage of time and medical advances. Those who have been treating asthmatics for several decades will have been able to witness these developments. At first, the treatment of asthmatic crises of various intensities formed a large part of our work since the therapeutic tools available were often insufficiently active and quick acting, especially in emergencies. Similarly, as the only drugs available were theophyline, and later chromones, another concern was to prevent recurrences for which environmental measures were of supreme importance. Systemic corticoids, which were much prescribed at that time, had severe adverse effects, above all in children, and could eventually lead to corticoid dependence, a difficult problem to resolve. Consequently, the indiscriminate use of these drugs had to be eradicated. Lastly, as now, immunotherapy was available as specific treatment. In line with our experience, this therapy obtained the most favorable evolution in our patients. The concept of «quality of life» was pushed into our subconscious since there were more serious problems to solve such as to reassure adult patients and the parents of affected children, as well as to reassure older children who were aware of the seriousness of their condition. Familial anxiety was a serious problem. Parents would appear in consulting rooms with an air of unease, naturally worried by their children's condition and by the severity of the crisis, as well as by the effect of these on the family. Some parents had other children without asthma who were deprived of certain activities because of an asthmatic sibling.
This permeable attempts to show the difference between the past and current state of affairs. Asthmatic crises continue to be severe and the number of asthmatics has risen. However, adult patients, the parents of asthmatic children and children themselves know that they can often resolve the crisis relatively easily, without having to seek the help of the doctor or visit the emergency department. Moreover, current long-acting antiinflammatory and bronchodilatory medication, mainly inhaled, has considerably improved prognosis. Consequently, the issue now is to «live better» with the disease, that is, to achieve «quality of life». Quality of life is nothing other than the patient's perception of the effects of the disease and of the preventive measures, including mediction, that have to be taken daily or frequently (1). This is the goal of «developed countries» in which «living well» has become a primordial aim.
In periodic follow-ups the patients provide information on their health status that may be influenced by their recent state of mind and, in children, the information given may even contradict parent's or relatives' opinions. Consequently, during the last decade several questionnaires have been developed to obtain more objective information and to evaluate both recent status and, if the questionnaire is periodically readministered, evolution over a period of time (2).
With this aim, many questionnaires have been designed for asthma, rhinoconjunctivitis, and other non-allergic chronic diseases. The difficulties lie in creating questions that are easy to understand, whatever the patient's educational attainment, that do not give rise to confusion, that require a concrete answer and that, to certain extent, can be scored according to symptom intensity (3). Another difficulty in evaluating quality of life involves the patient's lifestyle: highly active individuals will perceive greater difficulties as their social and sports activities will be limited while sedentary individuals, who are not deprived of these activities, will nor perceive such limitations.
Translating the questions to several languages also presents problems due to cultural differences in the way sensations and feelings are expressed. Hence, questionnaires need to be validated in each country, since concepts may vary even between countries sharing the same language (4). With this aim, Silva et al. have translated a questionnaire to evaluate quality of life in children with allergic rhinitis to Portuguese. The results of their study are published in the present edition of Allergologia et immunopathologia (5).
F. Muñoz-López
