الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic respiratory diseases represent a challenge to public health because of their increasing frequency and severity about the projected trends and economic impact. Several studies have reported the association between body mass index (BMI) and asthma prevalence with an improvement in asthma severity after weight loss in adult obese asthmatic patients.
The aim of the present study was to assess health related quality of life of obese and non-obese asthmatic patients in Alexandria Family Health Centers. The specific objectives were:
1. To compare health related quality of life of obese asthmatic with non-obese asthmatic patients.
2. To assess the effect of implementation of nutrition intervention program on the health related quality of life of obese asthmatic patients.
3. To assess the level of knowledge of family physicians concerning health related quality of life of asthma.
To conduct the present study, the following tools were used:
1. A pre-designed interview questionnaire was used to collect socio-demographic
data and medical history of asthmatic patients.
2. A pre-designed validated Arabic version for disease specific quality of life interview questionnaire (AQLA) was used to assess health related quality of life of obese and non obese asthmatic patients.
3. Anthropometric measurements as weight and height were taken according to criteria of Gibson for calculation of body mass index of asthmatic patients.
4. A weekly written diet menu was constructed and discussed with asthmatic patients individually as dietary intervention program.
5. A pre-designed self administered questionnaire to assess the level of knowledge of family physicians working in the study family health centers.
Data were subjected to statistical analysis and interpretation. The results of the present study could be summarized as follow:
1. The majority of the obese asthmatic patients attending family health centers
(74.3%) attempted reducing their weight and all attempts were by using diet with lesser satisfaction results in the obese patients than non-obese patients.
2. The majority of the obese and the non-obese patients came to the clinics at family health centers for follow up of acute conditions.
3. Nearly all obese asthmatic patients attending family health centers (97.1%) didn’t practice any exercise other than walking. Nearly one third of the sample (obese and non-obese) were smokers.
4. Nearly all the obese and non-obese asthmatic patients had no parents consanguinity (94.3%).
5. The highest percentage in obese asthmatic patients were with low education level, while the highest percentage in non-obese asthmatic patients were with middle education level.
6. Total health related quality of life with its four domains among obese asthmatic
patients was significantly lower than that among non-obese asthmatic patients.
7. Body mass index and body fat percentage of obese asthmatic patients improved significantly after using low caloric diet for 8 weeks.
8. Health related quality of life of obese asthmatic patients improved significantly following low caloric diet for weight reduction.
9. The majority of family physicians at family health centers (62.5%) had fair level of knowledge about health related quality of life of asthma. All family physicians at family health centers who had been trained on respiratory health problems had good level of knowledge, about health related quality of life of asthma.
10. Family physicians with (20-30 years) and more than (30 years) of experience had good level of knowledge concerning health related quality of life of asthma
11. Family physicians with less than 5 years and 5-15 years of practice in family field had good level of knowledge about health related quality of life of asthma
12. The majority of family physicians (75%) had good level of knowledge about the effect of weight reduction on asthma symptoms control.
13. More than half of family physicians had good level of knowledge about etiology and clinical hallmarks of asthma, pharmacological treatment, health related quality of life and effect of asthma on work attendance.
14. More than one third of family physicians knew the characteristics of severe persistent asthma, environmental agents affecting severity of asthma and psychological effect of asthma on patients life.
Accordingly, the followings can be recommended: A. Recommendations for asthmatic patients:
1. To encourage regular exercise and physical activity. It is recommended that
people perform 30 minutes of moderately strenuous exercise at least 5 days a week.
2. To instruct following low caloric balanced diet aiming to maintain the ideal body weight.
3. To advised about adherence to medications and compliance to treatment plan.
4. To avoid exposure to irritants or polluted air.
5. To encourage joining smoking cessation programs.
B. Recommendations for family physicians:
1. To build good relation and communication with their patients to get better
provision of health care.
2. To be aware of the benefits of patients’ education and self-management in asthma which improve the QL and reduce the rate of exacerbations.
3. To be aware of the importance of QL as a main goal in contorting asthma symptoms.
4. To advise obese and overweight asthmatic patients to engage in lifestyle modification program to get better outcomes of therapeutic management.
5. To coordinate a multidisciplinary team to face the challenge of improving QL of asthmatic patients and better adaptation to their society.
C. Recommendations for Ministry of Health:
1. To apply continuous training and retraining of family physicians in order to
keep them up to date with international guidelines and increase access to diagnostic facilities.
2. To adapt international guidelines to local realities to improve standard of asthma care.
3. To Improve asthma control strategies as they enhance patients QL and productivity.
4. To emphasize the importance of PHC role in improving HRQL of asthmatic patients.
5. To develop life style modification programs integrated with primary health care services for better management of non communicable diseases including asthma.
6. To reduce patients- to- physicians ratio for the sake of prolongation of consultation time, which gives the chance to proper history taking, complete examination, developing of proper therapeutic management and asking about all QL domains that, gives the patients enough time to express his problems clearly.