Am. J. Respir. Crit. Care Med., Volume 157, Number 3, March 1998, 785-790

Comparison of Discriminative Properties among Disease-specific Questionnaires for Measuring Health-related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

TAKASHI HAJIRO, KOICHI NISHIMURA, MITSUHIRO TSUKINO, AKIHIKO IKEDA, HIROSHI KOYAMA, and TAKATERU IZUMI

Chest Disease Research Institute, Kyoto University, Kyoto, Japan

Three disease-specific, health-related quality of life (HRQL) questionnaires have been introduced to assess patients with chronic obstructive pulmonary disease (COPD): the St. George's Respiratory Questionnaire (SGRQ), the Breathing Problems Questionnaire (BPQ), and the Chronic Respiratory Disease Questionnaire (CRQ). The purpose of the present study was to make comparisons between the SGRQ  , the BPQ  , and the CRQ in their discriminative properties, and to clarify the characteristics of each questionnaire. One hundred forty-three patients with mild to severe COPD completed pulmonary function tests, progressive cycle ergometer testing for exercise capacity, assessment of dyspnea, anxiety, and depression, and assessment of HRQL. The frequency distributions of the questionnaire scores showed that the SGRQ and the CRQ were normally distributed and that the BPQ was skewed toward low scores. Relationships between all dimensions of the three questionnaires were significant (correlation coefficients [Rs] = 0.74 to 0.86). The three questionnaires had significant but weak correlations (Rs = 0.24 to 0.36) with some physiologic variables (VC, FEV₁, and DL_CO/VA) and mild to moderate correlations with exercise capacity and assessment of dyspnea, anxiety, and depression. Stepwise multiple regression analyses revealed that the Baseline Dyspnea Index (BDI) score, anxiety by the Hospital Anxiety Depression Scale (HAD), and maximal oxygen uptake ( O₂max) accounted for 61% of the variance in the SGRQ and that the BDI and anxiety of the HAD accounted for 53 and 49% of the variance in the BPQ and the CRQ  , respectively. Dyspnea and psychologic status impacted the HRQL in patients with COPD. Although no substantial differences between the SGRQ  , the BPQ  , and the CRQ were evident in the correlations with physiologic parameters and the influential factors, the BPQ was found to be less discriminatory than the SGRQ and the CRQ in evaluating HRQL cross-sectionally.

This article has been cited by other articles:

				G. H Markovitz and C. B Cooper Review series: Rehabilitation in non COPD: Mechanisms of exercise limitation and pulmonary rehabilitation for patients with pulmonary fibrosis/restrictive lung disease Chronic Respiratory Disease, February 1, 2010; 7(1): 47 - 60. [Abstract] [PDF]

				S Dorman, C Jolley, A Abernethy, D Currow, M Johnson, M Farquhar, G Griffiths, T Peel, S Moosavi, A Byrne, et al. Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup Palliative Medicine, April 1, 2009; 23(3): 213 - 227. [Abstract] [PDF]

				J. Maurer, V. Rebbapragada, S. Borson, R. Goldstein, M. E. Kunik, A. M. Yohannes, N. A. Hanania, and for the ACCP Workshop Panel on Anxiety and Depress Anxiety and Depression in COPD: Current Understanding, Unanswered Questions, and Research Needs Chest, October 1, 2008; 134(4_suppl): 43S - 56S. [Abstract] [Full Text] [PDF]

				M. L. Duiverman, J. B. Wempe, G. Bladder, H. A. M. Kerstjens, and P. J. Wijkstra Health-related quality of life in COPD patients with chronic respiratory failure Eur. Respir. J., August 1, 2008; 32(2): 379 - 386. [Abstract] [Full Text] [PDF]

				M. Cazzola, W. MacNee, F. J. Martinez, K. F. Rabe, L. G. Franciosi, P. J. Barnes, V. Brusasco, P. S. Burge, P. M. A. Calverley, B. R. Celli, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers Eur. Respir. J., February 1, 2008; 31(2): 416 - 469. [Abstract] [Full Text] [PDF]

				K. A. Riekert, S. J. Bartlett, M. P. Boyle, J. A. Krishnan, and C. S. Rand The Association Between Depression, Lung Function, and Health-Related Quality of Life Among Adults With Cystic Fibrosis Chest, July 1, 2007; 132(1): 231 - 237. [Abstract] [Full Text] [PDF]

				S. Dorman, A. Byrne, and A. Edwards Which measurement scales should we use to measure breathlessness in palliative care? A systematic review Palliative Medicine, April 1, 2007; 21(3): 177 - 191. [Abstract] [PDF]

				C. Casanova, C. G. Cote, J. M. Marin, J. P. de Torres, A. Aguirre-Jaime, R. Mendez, L. Dordelly, and B. R. Celli The 6-min walking distance: long-term follow up in patients with COPD Eur. Respir. J., March 1, 2007; 29(3): 535 - 540. [Abstract] [Full Text] [PDF]

				L. Beretta, A. Santaniello, A. Lemos, M. Masciocchi, and R. Scorza Validity of the Saint George's Respiratory Questionnaire in the evaluation of the health-related quality of life in patients with interstitial lung disease secondary to systemic sclerosis Rheumatology, February 1, 2007; 46(2): 296 - 301. [Abstract] [Full Text] [PDF]

				M. J. Berry, N. E. Adair, and W. J. Rejeski Use of Peak Oxygen Consumption in Predicting Physical Function and Quality of Life in COPD Patients Chest, June 1, 2006; 129(6): 1516 - 1522. [Abstract] [Full Text] [PDF]

				E. F. M. Wouters Approaches to Improving Health Status in Chronic Obstructive Pulmonary Disease: One or Several? Proceedings of the ATS, May 1, 2006; 3(3): 262 - 269. [Abstract] [Full Text] [PDF]

				N F Schlecht, K Schwartzman, and J Bourbeau Dyspnea as clinical indicator in patients with chronic obstructive pulmonary disease Chronic Respiratory Disease, October 1, 2005; 2(4): 183 - 191. [Abstract] [PDF]

				G. Xie, Y. Li, P. Shi, B. Zhou, P. Zhang, and Y. Wu Baseline Pulmonary Function and Quality of Life 9 Years Later in a Middle-Aged Chinese Population Chest, October 1, 2005; 128(4): 2448 - 2457. [Abstract] [Full Text] [PDF]

				M. A. Martinez-Garcia, M. Perpina-Tordera, P. Roman-Sanchez, and J. J. Soler-Cataluna Quality-of-Life Determinants in Patients With Clinically Stable Bronchiectasis Chest, August 1, 2005; 128(2): 739 - 745. [Abstract] [Full Text] [PDF]

				H. J. Schunemann, R. Goldstein, M. J. Mador, D. McKim, E. Stahl, M. Puhan, L. E. Griffith, B. Grant, P. Austin, R. Collins, et al. A randomised trial to evaluate the self-administered standardised chronic respiratory questionnaire Eur. Respir. J., January 1, 2005; 25(1): 31 - 40. [Abstract] [Full Text] [PDF]

				B. R. Celli, C. G. Cote, J. M. Marin, C. Casanova, M. Montes de Oca, R. A. Mendez, V. Pinto Plata, and H. J. Cabral The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease N. Engl. J. Med., March 4, 2004; 350(10): 1005 - 1012. [Abstract] [Full Text] [PDF]

				C. E. Cox, J. F. Donohue, C. D. Brown, Y. P. Kataria, and M. A. Judson The Sarcoidosis Health Questionnaire: A New Measure of Health-related Quality of Life Am. J. Respir. Crit. Care Med., August 1, 2003; 168(3): 323 - 329. [Abstract] [Full Text] [PDF]

				J.R. Curtis and D.L. Patrick The assessment of health status among patients with COPD Eur. Respir. J., June 1, 2003; 21(41_suppl): 36S - 45s. [Abstract] [Full Text] [PDF]

				T. Oga, K. Nishimura, M. Tsukino, S. Sato, and T. Hajiro Analysis of the Factors Related to Mortality in Chronic Obstructive Pulmonary Disease: Role of Exercise Capacity and Health Status Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 544 - 549. [Abstract] [Full Text] [PDF]

				S. L. Chan, M. M. Chan-Yeung, G. C. Ooi, C. L. Lam, T. F. Cheung, W. K. Lam, and K. W. Tsang Validation of the Hong Kong Chinese Version of the St. George Respiratory Questionnaire in Patients With Bronchiectasis Chest, December 1, 2002; 122(6): 2030 - 2037. [Abstract] [Full Text] [PDF]

				T. Oga, K. Nishimura, M. Tsukino, S. Sato, T. Hajiro, A. Ikeda, and M. Mishima Health status measured with the CRQ does not predict mortality in COPD Eur. Respir. J., November 1, 2002; 20(5): 1147 - 1151. [Abstract] [Full Text] [PDF]

				Y. F. Heijdra, V. M. Pinto-Plata, L. A. Kenney, J. Rassulo, and B. R. Celli Cough and Phlegm Are Important Predictors of Health Status in Smokers Without COPD* Chest, May 1, 2002; 121(5): 1427 - 1433. [Abstract] [Full Text] [PDF]

				J. P. de Torres, V. Pinto-Plata, E. Ingenito, P. Bagley, A. Gray, R. Berger, and B. Celli Power of Outcome Measurements to Detect Clinically Significant Changes in Pulmonary Rehabilitation of Patients With COPD* Chest, April 1, 2002; 121(4): 1092 - 1098. [Abstract] [Full Text] [PDF]

				S. D. Aaron, K. L. Vandemheen, J. J. Clinch, J. Ahuja, R. J. Brison, G. Dickinson, and P. C. Hebert Measurement of Short-term Changes in Dyspnea and Disease-Specific Quality of Life Following an Acute COPD Exacerbation Chest, March 1, 2002; 121(3): 688 - 696. [Abstract] [Full Text] [PDF]

				J E A Williams, S J Singh, L Sewell, G H Guyatt, and M D L Morgan Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR) Thorax, December 1, 2001; 56(12): 954 - 959. [Abstract] [Full Text] [PDF]

				P W Jones Health status measurement in chronic obstructive pulmonary disease Thorax, November 1, 2001; 56(11): 880 - 887. [Abstract] [Full Text] [PDF]

				C.P. Engstrom, L.O. Persson, S. Larsson, and M. Sullivan Health-related quality of life in COPD: why both disease-specific and generic measures should be used Eur. Respir. J., July 1, 2001; 18(1): 69 - 76. [Abstract] [Full Text] [PDF]

				L. J. DOWSON, C. NEWALL, P. J. GUEST, S. L. HILL, and R. A. STOCKLEY Exercise Capacity Predicts Health Status in {alpha}1-Antitrypsin Deficiency Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 936 - 941. [Abstract] [Full Text]

				B. CHANG, J. STEIMEL, D. R. MOLLER, R. P. BAUGHMAN, M. A. JUDSON, H. YEAGER Jr., A. S. TEIRSTEIN, M. D. ROSSMAN, and C. S. RAND Depression in Sarcoidosis Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 329 - 334. [Abstract] [Full Text]

				V. Leyenson, S. Furukawa, A. M. Kuzma, F. Cordova, J. Travaline, and G. J. Criner Correlation of Changes in Quality of Life After Lung Volume Reduction Surgery With Changes in Lung Function, Exercise, and Gas Exchange Chest, September 1, 2000; 118(3): 728 - 735. [Abstract] [Full Text] [PDF]

				D. A. Mahler How Should Health-Related Quality of Life Be Assessed in Patients With COPD? Chest, February 1, 2000; 117 (2009): 54S - 57S. [Abstract] [Full Text] [PDF]

				T. Hajiro, K. Nishimura, M. Tsukino, A. Ikeda, T. Oga, and T. Izumi A Comparison of the Level of Dyspnea vs Disease Severity in Indicating the Health-Related Quality of Life of Patients With COPD* Chest, December 1, 1999; 116(6): 1632 - 1637. [Abstract] [Full Text] [PDF]

				M. R.-v. Mölken, B. Roos, and J A Van Noord An empirical comparison of the St George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ) in a clinical trial setting Thorax, November 1, 1999; 54(11): 995 - 1003. [Abstract] [Full Text]

				T. HAJIRO, K. NISHIMURA, P. W. JONES, M. TSUKINO, A. IKEDA, H. KOYAMA, and T. IZUMI A Novel, Short, and Simple Questionnaire to Measure Health-related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., June 1, 1999; 159(6): 1874 - 1878. [Abstract] [Full Text]

				T. HAJIRO, K. NISHIMURA, M. TSUKINO, A. IKEDA, H. KOYAMA, and T. IZUMI Analysis of Clinical Methods Used to Evaluate Dyspnea in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., October 1, 1998; 158(4): 1185 - 1189. [Abstract] [Full Text] [PDF]