Introduction
What is new?
Key finding- •
The Clinical COPD Questionnaire, Chronic Respiratory Questionnaire, Maugeri Respiratory Failure-28 Questionnaire, and Severe Respiratory Insufficiency (SRI) Questionnaire showed to be reliable and valid questionnaires in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure requiring ventilatory support.
What this adds to what was known?- •
On balance, the SRI scored best, making it the preferred questionnaire for measurement of health-related quality of life in patients with very severe COPD.
What is the implication and what should change now?- •
We suggest that future studies on the effects of chronic noninvasive ventilation in COPD use the SRI in addition to a more general disease-specific questionnaire.
Health-related quality of life (HRQL) assessment in patients with chronic obstructive pulmonary disease (COPD) has become more common over the last two decades, and its importance in clinical trials has been recognized by many health care institutions [1]. Quite a few disease-specific questionnaires in the field of COPD have been developed, some of which have been shown to be valid, reliable, and responsive in several stages of severity of this disease; for example, the Chronic Respiratory Questionnaire (CRQ) [2] and Clinical COPD Questionnaire (CCQ) [3]. Others were designed for a more specific subset of COPD patients. Both the Maugeri Respiratory Failure-28 (MRF-28) Questionnaire [4] and the Severe Respiratory Insufficiency (SRI) Questionnaire [5] were originally developed for a mixed group of patients with respiratory failure (not necessarily COPD) receiving chronic noninvasive positive pressure ventilation (NPPV). In addition, they have also shown to be valid and reliable specifically in COPD patients with stable chronic hypercapnic respiratory failure (CHRF) [6]. One trial on chronic NPPV in COPD with CHRF [7] showed that the SRI was more related to anxiety and depression, whereas the MRF-28 added the cognitive domain compared with the CRQ and therefore suggested using both the SRI and the MRF-28 as they assess different aspects of HRQL in these patients.
The lack of agreement on which HRQL questionnaire to use has contributed to the fact that evidence for the use of chronic NPPV in patients with stable COPD is still contradictory [8], [9], [10]. Among others, the pooling of results on HRQL is hampered in this way.
Not only is chronic NPPV in stable COPD of interest but also the role of chronic NPPV in COPD after an episode of acute respiratory failure requiring ventilatory support in hospital [11]. In Europe, a few studies on chronic NPPV after acute exacerbation are currently in process, and therefore, it is of importance to find the appropriate questionnaires for this precise area. As there are limited data on HRQL in this specific group, the aim of the present study is to assess and compare the reliability and validity of the CCQ, CRQ, MRF-28, and SRI in COPD patients with CHRF during an admission requiring ventilatory support.