Improving quality of life (QOL) is a central goal in asthma care, but it should extend beyond symptom control to also take activity levels, emotional well-being, and the avoidance of environmental triggers into account. Clinicians can assess these domains even during time-limited visits, while also addressing comorbidities and social factors that shape patients’ lived experiences.

QOL is often reduced in patients with asthma, especially in those with severe or uncontrolled asthma. Improving QOL should be one of the main goals in managing asthma, so assessing QOL domains is an important thing to do at every patient visit.

In general, if you look at the different available QOL assessment questionnaires, they often focus on asthma control. Certainly, QOL correlates with asthma symptoms and disease severity, but it also involves more than symptom control. QOL in asthma is associated with activity limitation and exercise tolerance, emotional well-being, and environmental restrictions. There are tools available that can be used to support these assessments, such as the Asthma Quality of Life Questionnaire (AQLQ) and the Living With Asthma Questionnaire (LWAQ). However, most QOL questionnaires are long and are most often only used in clinical trials.

Even during a time-constrained visit, a clinician can still assess a patient’s QOL. Assessing symptom control is important, and so is asking about activity and how much a patient can do. We should assess whether they have to reduce their activity level and how asthma is affecting their ability to perform activities of daily living, participate in sports, or even engage in sexual activity. Then, assessing emotional function, including anxiety and depression, is important, and asking patients about lifestyle changes, the avoidance of environmental triggers, and occupational participation can be helpful. These are a part of QOL assessments that patients need to be asked about.

It is important to note that the assessment of QOL in asthma also involves the evaluation of comorbidities. In addition to anxiety and depression, sleep disturbances, gastroesophageal reflux disease, and obesity are some important comorbid conditions that can adversely affect QOL in asthma. Moreover, there are sociodemographic factors to consider. I work in a county hospital, and I see that a lot of things can affect QOL in asthma, such as a patient’s education level, socioeconomic status, and health literacy. Unfortunately, these patients tend to have a worse QOL than those who are more privileged. Even just trying to get medications paid for can be a big issue for these patients, and sometimes they feel desperate, which may affect how they feel emotionally.

In addition to optimizing pharmacologic therapy to control asthma, there are nonpharmacologic interventions that I recommend to improve a patient’s QOL. For example, I may recommend increasing exercise or getting involved in other activities. Participating in exercise programs has been shown to improve outcomes in asthma. Many of my patients with asthma are obese, so I advise them to talk to their care team about trying to lose weight because it has been shown that weight loss in those with asthma can improve QOL and asthma control.

For patients with asthma who have anxiety and perhaps depression, I try to get them involved in programs that include meditation and exercise. Getting patients involved in support groups can also be helpful. Additionally, I have an asthma educator on my team who sits down with patients and goes over their triggers, concerns, and fears, and we address them one by one. Each patient with asthma should be taken as an individual. There is no single “recipe” for everyone, and we have to tailor our approach to QOL improvement based on the individual patient.