History Of Previous Exacerbations Research Articles

Optimum treatment for chronic obstructive pulmonary disease exacerbation prevention.

An exacerbation of chronic obstructive pulmonary disease (COPD) is defined as an acute worsening of symptoms greater than the usual day to day variation that requires increased pharmacotherapy (1). Some COPD patients suffer with exacerbations regularly, and the history of previous exacerbations is the best predictor for the risk of future exacerbations (2). The Global initiative for chronic Obstructive Lung Disease (GOLD) uses a threshold of ≥ two exacerbations or one hospitalization in the last year to identify patients with an increased risk of future exacerbations (3).

Independent effect of prior exacerbation frequency and disease severity on the risk of future exacerbations of COPD: a retrospective cohort study.

Few studies have researched the independent effect of COPD severity on the risk of future exacerbations adjusted by previous exacerbation frequency. We aimed to analyse the independent effect of COPD severity on the risk of exacerbations in the following year, and whether this effect was stronger or not than the effect of a previous history of exacerbations. We conducted a retrospective population-based cohort study including 900 patients with confirmed COPD. Exacerbation frequency was observed for the previous year and for the following year. Patients were defined as ‘Frequent Exacerbator’ (FE) phenotype if they suffered ⩾2 exacerbations in a year, and were categorised according to the severity of COPD (GOLD Grades 1–4). Odds ratios (ORs) were estimated by logistic regression adjusting for age, gender, smoking status, severity of COPD and being FE in the previous year. The main predictor of being FE among all grades of COPD severity was a history of frequent exacerbations in the previous year: adjusted OR 4.97; 95% confidence interval (CI) (3.54–6.97). COPD severity was associated with a higher risk of being FE: Crude OR GOLD Grade 4 3.86; 95% CI (1.50–9.93). However, this association diminished after adjusting for being FE in the previous year: adjusted OR 2.08; 95% CI (0.75–5.82). Our results support that a history of frequent exacerbations in the previous year is the most important independent predictor of exacerbations in the following year, also among the most severe COPD patients. Severity of COPD would be associated with a higher risk of exacerbations, but this effect would be partly determined by the exacerbations suffered in the previous year.

The discovery of roflumilast for the treatment of chronic obstructive pulmonary disease

ABSTRACTIntroduction: Cyclic adenosine monophosphate (cAMP) phosphodiesterase (PDE)4 is an intracellular target that can be exploited to the treat chronic obstructive pulmonary disease (COPD), given that it is expressed in all inflammatory cells implicated in this inflammatory airways disease. At the present time, roflumilast is the only PDE4 inhibitor that has received regulatory approval for use in patients with COPD.Areas covered: The preclinical, clinical and post-marketing development of roflumilast is described. Furthermore, a critical analysis of the clinical data and positioning of this drug is undertaken in this reviewExpert opinion: The identification of a subset of COPD patients, namely those suffering from severe airflow obstruction with symptoms of chronic cough and sputum and a history of previous exacerbations, as a specific target for roflumilast with the goal of reducing exacerbations, was entirely casual because the delineation of a ‘chronic bronchitis’ responder group was clearly a post-hoc finding. However, it was useful to design prospective clinical trials that demonstrated reduced exacerbations in this specific subset of patients towards whom roflumilast therapy is now targeted. In any case, these pivotal trials still do not provide more accurate identification of the type of exacerbation to be treated by roflumilast. The identification of the right biological COPD exacerbation phenotype and/or the right clinical COPD phenotype are the only means that could justify the use of roflumilast as a first line anti-inflammatory therapeutic approach.

Accurate reporting of adherence to inhaled therapies in adults with cystic fibrosis: methods to calculate "normative adherence".

BackgroundPreventative inhaled treatments in cystic fibrosis will only be effective in maintaining lung health if used appropriately. An accurate adherence index should therefore reflect treatment effectiveness, but the standard method of reporting adherence, that is, as a percentage of the agreed regimen between clinicians and people with cystic fibrosis, does not account for the appropriateness of the treatment regimen. We describe two different indices of inhaled therapy adherence for adults with cystic fibrosis which take into account effectiveness, that is, “simple” and “sophisticated” normative adherence.Methods to calculate normative adherenceDenominator adjustment involves fixing a minimum appropriate value based on the recommended therapy given a person’s characteristics. For simple normative adherence, the denominator is determined by the person’s Pseudomonas status. For sophisticated normative adherence, the denominator is determined by the person’s Pseudomonas status and history of pulmonary exacerbations over the previous year. Numerator adjustment involves capping the daily maximum inhaled therapy use at 100% so that medication overuse does not artificially inflate the adherence level.Three illustrative casesCase A is an example of inhaled therapy under prescription based on Pseudomonas status resulting in lower simple normative adherence compared to unadjusted adherence. Case B is an example of inhaled therapy under-prescription based on previous exacerbation history resulting in lower sophisticated normative adherence compared to unadjusted adherence and simple normative adherence. Case C is an example of nebulizer overuse exaggerating the magnitude of unadjusted adherence.ConclusionDifferent methods of reporting adherence can result in different magnitudes of adherence. We have proposed two methods of standardizing the calculation of adherence which should better reflect treatment effectiveness. The value of these indices can be tested empirically in clinical trials in which there is careful definition of treatment regimens related to key patient characteristics, alongside accurate measurement of health outcomes.

The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD.

IntroductionChronic obstructive pulmonary disease (COPD) exacerbations have a negative impact on the quality of life of patients and the evolution of the disease. We have investigated the prognostic value of several health-related quality of life questionnaires to predict the appearance of a composite event (new ambulatory or emergency exacerbation, hospitalization, or death) over a 1-year follow-up.MethodsThis was a multicenter, prospective, observational study. Patients completed four questionnaires after recovering from an exacerbation (COPD Assessment Test [CAT], a Clinical COPD Questionnaire [CCQ], COPD Severity Score [COPDSS], and Airways Questionnaire [AQ20]). Patients were followed-up until the appearance of the composite event or for 1 year, whichever came first.ResultsA total of 497 patients were included in the study. The majority of them were men (89.7%), with a mean age of 68.7 (SD 9.2) years, and a forced expiratory volume in 1 second of 47.1% (SD 17.5%). A total of 303 (61%) patients experienced a composite event. Patients with an event had worse mean scores of all questionnaires at baseline compared to patients without event: CAT=12.5 vs 11.3 (P=0.028); CCQ=2.2 vs 1.9 (P=0.013); COPDSS=12.3 vs 10.9 (P=0.001); AQ20=8.3 vs 7.5 (P=0.048). In the multivariate analysis, only previous history of exacerbations and CAT score ≥13.5 were significant risk factors for the composite event. A CAT score ≥13.5 increased the predictive value of previous exacerbations with an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.829–0.899; P=0.001).ConclusionThe predictive value of previous exacerbations significantly increased only in one of the four trialled questionnaires, namely in the CAT questionnaire. However, previous history of exacerbations was the strongest predictor of the composite event.

Impact de la BPCO : du handicap aux exacerbations

COPD is a common disease characterized by health status impairment and disability that is usually progressive. Exacerbations of COPD, an acute event in the course of the disease, have effects on symptoms and patient's quality of life. Assessment of symptoms and risk of exacerbations is useful to guide strategy management of the disease. COPD disability includes different aspects. Its assessment needs to consider the classification of severity of airflow limitation, symptoms, comorbidities and impairment of patient's health-related quality of life. The rate at which exacerbations occur varies between patients. History of previous exacerbations and severity of airflow limitation are the best predictors of the frequency and severity of exacerbations. Severity of the symptoms is associated with an increased risk of exacerbations. Exacerbations increase deterioration in health status and leads to severe disability, inducing a vicious circle from disability to exacerbations. At an individual patient level, an understanding of the impact of COPD requires to assess the patient's disability, the risk of future exacerbations, and the identification of comorbidities.

Value of copeptin and C-reactive protein in acute exacerbation of chronic obstructive pulmonary disease

ObjectivesAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) describes the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. The aim of this work is to study the value of copeptin and C-reactive protein in AECOPD. Patients and methodsThe study enrolled 31 patients with AECOPD and 10 control subjects. All patients were subjected to history taking, clinical examination, arterial blood gases analysis and sputum culture for bacteriological examination. Serum samples were obtained from the patients on admission, 3days and 14days after and from control subjects. The samples were analyzed for copeptin and CRP levels. ResultsThe copeptin level on admission was significantly higher in AECOPD patients than the control subjects. The copeptin and CRP showed a statistically significant decline over the study duration but did not correlate with each other. ROC analysis curve showed that a copeptin level >14pg/dl on admission had a sensitivity of 70% and specificity of 90% in predicting AECOPD and a level of >15pg/dl on the fourteenth day had a sensitivity of 100% and specificity of 90% in predicting in-hospital mortality. Copeptin correlated significantly directly with the presence of bacterial infection and inversely with both PaO2 and PaCO2. Neither the copeptin nor CRP correlated with the COPD severity as expressed by the FEV1%, BODE index and previous history of exacerbations. ConclusionCopeptin has a good sensitivity and excellent specificity in predicting AECOPD. Additionally, it has good predilection for short term outcome and in-hospital mortality.

P237 Comparison of COPD exacerbations with once-daily QVA149 versus twice-daily salmeterol/fluticasone combination: the ILLUMINATE study

IntroductionExacerbations are the most frequent cause of hospitalisation and death among patients with COPD. Combinations of long-acting bronchodilators maximise bronchodilation and may reduce the risk of exacerbations. QVA149, a once-daily...

Factor analysis in predominantly severe COPD: Identification of disease heterogeneity by easily measurable characteristics

The clinical and demographic variables defining the heterogeneity of chronic obstructive pulmonary disease (COPD) are unclear. A post-hoc analysis of five randomised studies in patients with a history of previous exacerbations examined the clinical and demographic characteristics describing moderate-to-very-severe COPD. Factor analysis was performed on all continuous baseline demographic and clinical data, without variable selection. Analyses were based on the full cohort and on stratifications by pack-years smoked, smoking status, gender, and comorbidities; patient exacerbation history was analysed in two of the five studies. 6162 COPD patients were evaluated (70% male; 40% current smokers; mean pre-bronchodilator forced expiratory volume in 1 s [FEV1] 35.2% predicted). Baseline clinical and demographic variables loaded differentially on six factors with minimal overlap, explaining 60.4% of the heterogeneity: 1) symptoms (cough, dyspnoea, sleep disturbance), health status, reliever use; 2) pre-bronchodilator FEV1, FEV1/forced vital capacity, morning peak expiratory flow (PEF), body mass index (BMI); 3) blood pressure; 4) age, months since first COPD symptoms; 5) PEF variability; 6) pulse, FEV1 reversibility. Most factors loaded similarly in stratified and exacerbation analyses. BMI loaded with reversibility in females, and with age and months since first COPD symptoms in ex-smokers. Exacerbations loaded to factor 6. Readily available data can explain ≈ 60% of COPD heterogeneity in a large dataset of predominantly severe COPD patients. Factors were robust over determinants of disease outcome; gender, smoking status, pack-years smoked, and comorbidities. The main factors were largely unchanged by adding exacerbations. Only BMI loaded to other factors.

Inflammatory Biomarkers and Exacerbations in Chronic Obstructive Pulmonary Disease

Exacerbations of respiratory symptoms in chronic obstructive pulmonary disease (COPD) have profound and long-lasting adverse effects on patients. To test the hypothesis that elevated levels of inflammatory biomarkers in individuals with stable COPD are associated with an increased risk of having exacerbations. Prospective cohort study examining 61,650 participants with spirometry measurements from the Copenhagen City Heart Study (2001-2003) and the Copenhagen General Population Study (2003-2008). Of these, 6574 had COPD, defined as a ratio between forced expiratory volume in 1 second (FEV1) and forced vital capacity below 0.7. Baseline levels of C-reactive protein (CRP) and fibrinogen and leukocyte count were measured in participants at a time when they were not experiencing symptoms of exacerbations. Exacerbations were recorded and defined as short-course treatment with oral corticosteroids alone or in combination with an antibiotic or as a hospital admission due to COPD. Levels of CRP and fibrinogen and leukocyte count were defined as high or low according to cut points of 3 mg/L, 14 μmol/L, and 9 ×10(9)/L, respectively. During follow-up, 3083 exacerbations were recorded (mean, 0.5/participant). In the first year of follow-up, multivariable-adjusted odds ratios for having frequent exacerbations were 1.2 (95% CI, 0.7-2.2; 17 events/1000 person-years) for individuals with 1 high biomarker, 1.7 (95% CI, 0.9-3.2; 32 events/1000 person-years) for individuals with 2 high biomarkers, and 3.7 (95% CI, 1.9-7.4; 81 events/1000 person-years) for individuals with 3 high biomarkers compared with individuals who had no elevated biomarkers (9 events/1000 person-years; trend: P = 2 × 10(-5)). Corresponding hazard ratios using maximum follow-up time were 1.4 (95% CI, 1.1-1.8), 1.6 (95% CI, 1.3-2.2), and 2.5 (95% CI, 1.8-3.4), respectively (trend: P = 1 × 10(-8)). The addition of inflammatory biomarkers to a basic model including age, sex, FEV1 percent predicted, smoking, use of any inhaled medication, body mass index, history of previous exacerbations, and time since most recent prior exacerbation improved the C statistics from 0.71 to 0.73 (comparison: P = 9 × 10(-5)). Relative risks were consistent in those with milder COPD, in those with no history of frequent exacerbations, and in the 2 studies separately. The highest 5-year absolute risks of having frequent exacerbations in those with 3 high biomarkers (vs no high biomarkers) were 62% (vs 24%) for those with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades C-D (n = 558), 98% (vs 64%) in those with a history of frequent exacerbations (n = 127), and 52% (vs 15%) for those with GOLD grades 3-4 (n = 465). Simultaneously elevated levels of CRP and fibrinogen and leukocyte count in individuals with COPD were associated with increased risk of having exacerbations, even in those with milder COPD and in those without previous exacerbations. Further investigation is needed to determine the clinical value of these biomarkers for risk stratification.

Systemic Inflammation in Predicting COPD Exacerbations

EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMOnary disease (COPD) involve inflammatory events in the airway caused mostly by infection— bacterial, viral, or both. During the last 2 decades, the understanding of exacerbations has improved, and these exacerbations are now regarded as major contributors to cost of care, health status deterioration, loss of lung function, and mortality in COPD. However, treatment of exacerbations has not evolved significantly, and clinical failure rates (need for additional treatment or hospitalization) of 20% to 40% within 1 month are still prevalent. Prevention of exacerbations is at the forefront as a therapeutic goal in COPD. However, to apply preventive therapies effectively, identifying patients at risk for future exacerbations is critical but not simple. Chronic obstructive pulmonary disease is a heterogeneous disease with multiple phenotypes. Although the frequency of exacerbations is related to the severity of airflow obstruction, some patients with severe disabling lung disease never have exacerbations, whereas other patients with much less airflow obstruction have frequent exacerbations. Other clinical risk factors associated with frequent exacerbations include a history of previous exacerbations, poor diseasespecific health status, chronic bronchitis, and gastroesophageal reflux, with the strongest predictive factor being a history of previous exacerbations. If exacerbations worsen lung function and health status over time in patients with COPD, current predictive factors may simply rely on the consequences of prior exacerbations to predict future episodes. The current approach for identifying a high-risk patient to prevent exacerbations is likely “too little, too late.” Further refinement and earlier detection of exacerbation risk in COPD is clearly needed. In this issue of JAMA, Thomsen et al report findings from 2 large, population-based, prospective studies demonstrating that elevated levels of systemic inflammatory biomarkers (C-reactive protein, fibrinogen, and leukocyte count) were associated with future exacerbations of COPD. This association was observed after accounting for other variables important for determining the risk of exacerbations, especially lung function and history of exacerbations. (Chronic bronchitis and gastroesophageal reflux apparently were not included as potential risk factors.) The association had a stepwise pattern; elevations in levels of all 3 biomarkers had the highest utility in predicting exacerbations, whereas the predictive value was minimal to moderate if only 1 or 2 biomarkers were elevated. This study has several strengths, including a large number of patients (6574 with COPD and a total of 3083 exacerbations), prospective follow-up with no loss to follow-up, and reliable capture of exacerbations through a single central health care system database. The biomarkers studied are simple to measure, inexpensive, and readily available, and specific values are provided. Several aspects of experimental design need to be considered in interpreting the results. Chronic obstructive pulmonary disease was diagnosed if the ratio of forced expiratory volume in 1 second to forced vital capacity was less than 70%. Patients younger than age 40 years and those with selfreported asthma were excluded. Nevertheless, 1435 participants (22%) were life-long nonsmokers. Whether these patients truly had COPD or were elderly individuals with normal age-related reduction in lung elasticity is uncertain. The predictive value of the inflammatory biomarkers was attenuated in the nonsmoker subgroup. Because of the population-based rather than disease-targeted enrollment in this study, the proportion of patients with mild to moderate COPD is substantially larger than in other studies. Generalizability of their observations to more severe COPD may therefore be limited. The COPD severity distribution also likely explains the low exacerbation rate observed of 0.5 episodes per patient per year. Another factor that may have contributed to the low rate is the definition of exacerbation used, which included either a short course of corticosteroids (with or without antibiotics) or a hospital admission due to COPD. Many exacerbations, particularly in mild COPD, are diagnosed as acute bronchitis and treated with antibiotics only, and these episodes were not captured in this analysis. Another con-

Efficacy of Roflumilast in the COPD Frequent Exacerbator Phenotype

COPD exacerbations are associated with increased morbidity and mortality and can accelerate disease progression. The best predictor of future exacerbations is a history of previous exacerbations, which helps identify a frequent exacerbator phenotype. This post hoc analysis evaluated the effect of roflumilast, a drug known to reduce the COPD exacerbation rate, on exacerbation status. Pooled data from two 1-year, placebo-controlled, roflumilast (500 μg once daily) studies in patients with symptomatic COPD and severe airflow obstruction were evaluated (studies M2-124 and M2-125, ClinicalTrials.gov identifiers NCT00297102 and NCT00297115). A total of 3,091 patients were included in this analysis (62.5% with GOLD [Global Initiative for Chronic Obstructive Lung Disease] III COPD and 29.2% with GOLD 4 COPD). Based on their exacerbation frequency status in the previous year, patients were classified as frequent (two or more events) or infrequent (fewer than two events) exacerbators. Exacerbation frequency was analyzed at baseline and at year 1. Among frequent exacerbators treated with roflumilast, 32.0% still had frequent exacerbations at year 1 compared with 40.8% of placebo-treated patients (risk ratio, 0.799; P = .0148). Among infrequent exacerbators, 17.5% of roflumilast-treated patients became frequent exacerbators at year 1 compared with 22.9% of those taking placebo (risk ratio, 0.768; P = .0018). The reduction in severe exacerbations leading to hospitalization/death was similar between subgroups and occurred independently of concomitant long-acting β2-agonists or previous inhaled corticosteroid treatment. When analyzed by severity of airflow limitation, 26.4% of roflumilast-treated frequent exacerbators with GOLD III COPD remained frequent exacerbators at year 1 compared with 38.9% of those taking placebo (P = .0042). Treatment with roflumilast shifts patients from the frequent to the more stable infrequent exacerbator state. ClinicalTrials.gov; No.: NCT00297102 and NCT00297115; URL: www.clinicaltrials.gov.

GOLD 2011 disease severity classification in COPDGene: a prospective cohort study

The 2011 GOLD (Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease [COPD]) consensus report uses symptoms, exacerbation history, and forced expiratory volume (FEV1)% to categorise patients according to disease severity and guide treatment. We aimed to assess both the influence of symptom instrument choice on patient category assignment and prospective exacerbation risk by category. Patients were recruited from 21 centres in the USA, as part of the COPDGene study. Eligible patients were aged 45-80 years, had smoked for 10 pack-years or more, and had an FEV1/forced vital capacity (FVC) <0·7. Categories were defined with the modified Medical Research Council (mMRC) dyspnoea scale (score 0-1 vs ≥2) and the St George's Respiratory Questionnaire (SGRQ; ≥25 vs <25 as a surrogate for the COPD Assessment Test [CAT] ≥10 vs <10) in addition to COPD exacerbations in the previous year (<2 vs ≥ 2), and lung function (FEV1% predicted ≥50 vs <50). Statistical comparisons were done with k-sample permutation tests. This study cohort is registered with ClinicalTrials.gov, number NCT00608764. 4484 patients with COPD were included in this analysis. Category assignment using the mMRC scale versus SGRQ were similar but not identical. On the basis of the mMRC scale, 1507 (33·6%) patients were assigned to category A, 919 (20·5%) to category B, 355 (7·9%) to category C, and 1703 (38·0%) to category D; on the basis of the SGRQ, 1317 (29·4%) patients were assigned to category A, 1109 (24·7%) to category B, 221 (4·9%) to category C, and 1837 (41·0%) to category D (κ coefficient for agreement, 0·77). Significant heterogeneity in prospective exacerbation rates (exacerbations/person-years) were seen, especially in the D subcategories, depending on the risk factor that determined category assignment (lung function only [0·89, 95% CI 0·78-1·00]), previous exacerbation history only [1·34, 1·0-1·6], or both [1·86, 1·6-2·1; p<0·0001]). The GOLD classification emphasises the importance of symptoms and exacerbation risk when assessing COPD severity. The choice of symptom measure influences category assignment. The relative number of patients with low symptoms and high risk for exacerbations (category C) is low. Differences in exacerbation rates for patients in the highest risk category D were seen depending on whether risk was based on lung function, exacerbation history, or both. National Heart, Lung, and Blood Institute, and the COPD Foundation through contributions from AstraZeneca, Boehringer Ingelheim, Novartis, and Sepracor.

Current Control and Future Risk in Asthma Management

Despite international and national guidelines, poor asthma control remains an issue. Asthma exacerbations are costly to both the individual, and the healthcare provider. Improvements in our understanding of the therapeutic benefit of asthma therapies suggest that, in general, while long-acting bronchodilator therapy improves asthma symptoms, the anti-inflammatory activity of inhaled corticosteroids reduces acute asthma exacerbations. Studies have explored factors which could be predictive of exacerbations. A history of previous exacerbations, poor asthma control, poor inhaler technique, a history of lower respiratory tract infections, poor adherence to medication, the presence of allergic rhinitis, gastro-oesophageal reflux disease, psychological dysfunction, smoking and obesity have all been implicated as having a predictive role in the future risk of asthma exacerbation. Here we review the current literature and discuss this in the context of primary care management of asthma.

Validity and Reliability of the St. George's Respiratory Questionnaire in Asthmatic Patients

RationaleAsthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics.St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet.MethodsWe used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ‘Cohort for Reality and Evolution of Adult Asthma in Korea’ (COREA) since the year of 2005. Statistically, we used Cronbach's alpha coefficient for reliability and Pearson's coefficient for the correlation between SGRQ scores and various clinical factors.ResultsCronbach's alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively.ConclusionsSGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history. RationaleAsthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics.St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet. Asthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics. St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet. MethodsWe used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ‘Cohort for Reality and Evolution of Adult Asthma in Korea’ (COREA) since the year of 2005. Statistically, we used Cronbach's alpha coefficient for reliability and Pearson's coefficient for the correlation between SGRQ scores and various clinical factors. We used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ‘Cohort for Reality and Evolution of Adult Asthma in Korea’ (COREA) since the year of 2005. Statistically, we used Cronbach's alpha coefficient for reliability and Pearson's coefficient for the correlation between SGRQ scores and various clinical factors. ResultsCronbach's alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively. Cronbach's alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively. ConclusionsSGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history. SGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history.