St George's Respiratory Questionnaire Research Articles (Page 1)

"Student-delivered pulmonary and cardiac rehabilitation: Feasible, Effective, and Supports New Care Models".

Comparison of the effects of one-legged and two-legged exercise training on exercise capacity and fatigue in patients with sarcoidosis.

Efficacy of Liuzijue Qigong combined with conventional respiratory rehabilitation after thoracoscopic pulmonary nodule resection: A randomized clinical trial.

Efficacy of Pulmonary Rehabilitation on Patient-Reported Outcomes in Interstitial Lung Disease: A Quasi-Experimental Study.

IntroductionThe Dyspnea-12 is a brief patient reported tool assessing physical and emotional components of breathlessness. However, the reliability and effectiveness of the Chinese version of Dyspnea-12 (D-12-C) needs to be verified.PurposeThis study aimed to assess the reliability and validity of D-12-C in patients with chronic obstructive pulmonary disease (COPD) and investigate its associations with clinical outcomes of COPD.Patients and MethodsPatients from three centers completed baseline assessments (pulmonary function test, the COPD Assessment Test (CAT), the Modified Medical Research Council Dyspnea Scale (mMRC), the Hospital Anxiety and Depression Scale (HADS), St George’s Respiratory Questionnaire (SGRQ), Borg dyspnea scale, 6-minute walking distance (6MWD) and the history of exacerbations. The internal consistency, construct validity, convergent validity and reliability of the D-12-C were evaluated. The binary multivariate logistic regression analysis was performed to explore the influencing factors for hospitalization during follow-up.ResultsA total of 279 patients were recruited. Exploratory factor analysis divided the D-12-C into physical and affective dimensions. A high level of internal consistency was manifested by the Cronbach’s alpha values of the D-12-C with total scores, physical, and affective dimensions of 0.94, 0.96, and 0.92, respectively. The score of D-12-C increased as the GOLD or mMRC grade rose, and patients suffering from anxiety or depression had more severe dyspnea. The score of D-12-C was significantly correlated with CAT, mMRC, HADS, SGRQ and hospitalization during follow-up. Additionally, baseline D-12-C was an independent predictor of hospitalization during the one year follow-up (OR=1.086, 95% CI: 1.035–1.139, p < 0.001).ConclusionThe D-12-C demonstrated good internal consistency and validity in COPD. The score of D-12-C correlates with the clinical parameters of disease severity and predicts severe exacerbations of hospitalization, supporting its use in risk stratification and management planning to prevent adverse outcomes.

ObjectiveThe traditional BODE (Body-mass Index, Obstruction, Dyspnoea and Exercise) index can be challenging in routine practice. This study introduced the modified BODE (mBODE) index that replaces the exercise component with the activity domain of the St. George's Respiratory Questionnaire (SGRQ). Our study aimed to evaluate its relationship with baseline clinical characteristics and its predictive performance for exacerbations and mortality compared to the original index.MethodsData were extracted from the Korean COPD Subgroup Study cohort. The activity domain of the SGRQ was divided into quartiles, replacing the exercise component of the BODE index to define the mBODE index. Clinical outcomes were compared between quartiles of the BODE and mBODE indices. We analysed the associations of both scores with 1-year exacerbations and all-cause mortality.ResultsThis study enrolled 1765 individuals, and both scores were associated with moderate-to-severe and severe exacerbations. In the analysis of future exacerbation frequency, the Akaike information criterion (AIC) and log-likelihood values indicated that the mBODE index had better predictive performance than the BODE index in both models. In the analysis of the presence of future exacerbation, the AIC showed that the mBODE index had superior predictive performance compared to the BODE index. Furthermore, both indices predicted all-cause mortality in individuals with COPD (BODE: adjusted hazard ratio (aHR=2.53, p<0.001; mBODE: aHR=2.00, p<0.01).ConclusionsThe mBODE index reflected the clinical characteristics and showed association with exacerbations and mortality comparable to those of the traditional BODE index.

BackgroundIn asthma, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) was previously demonstrated to improve forced expiratory volume in 1 s (FEV1) and asthma control, but the mechanism by which this occurs, especially at the level of the small airways, is not well-understood. We asked the question, does FF/UMEC/VI influence asthma control by improving airway structure–function and airway occlusions? Hence, our objective was to measure airway structure–function using 129Xe magnetic resonance imaging (MRI) ventilation defect percentage (VDP), computed tomography (CT) and airwave oscillometry after 6-week single-inhaler FF/UMEC/VI and 1 year later.MethodsParticipants with Global Initiative for Asthma Step 4–5 (GINA4–5) asthma who were poorly controlled on inhaled corticosteroid/long-acting β-2 agonist (ICS/LABA) provided written informed consent to baseline, 6- and 12-week visits as well as an open-extension 1-year visit. All received FF/UMEC/VI (200/62.5/25 µg) at baseline and underwent MRI, spirometry, plethysmography and oscillometry, pre- and post-bronchodilator (BD). The Asthma Control Questionnaire, the Asthma Quality of Life Questionnaire (AQLQ) and St. George's Respiratory Questionnaire (SGRQ) were completed. CT was acquired at baseline and 1 year later.ResultsThirty-one participants (24 females, 54±15 yrs) completed the baseline visit, 28 (21 females, 54±15 yrs) completed the 6-week visit and 15 patients attended the 1-year visit. At 6-weeks, there was significantly improved pre-BD VDP (p=0.02), FEV1 (p=0.008), distal airways resistance (R5–19) (p=0.001), AQLQ (p<0.001) and SGRQ-scores (p=0.001), which persisted at 1 year. VDP improved in participants with elevated mucus score and eosinophil count, while R5–19 improvements were independent of type 2 inflammation. Mean airway mucus score, lumen area and total airway count were significantly improved at 1 year.ConclusionsIn participants with GINA4–5 asthma, who had been poorly controlled on ICS/LABA, single-inhaler FF/UMEC/VI resulted in improved VDP and FEV1 at 6-weeks. These improvements persisted 1-year later when airway markers were also significantly improved, consistent with the reversal of airway remodelling.

Objective: To evaluate the efficacy of benralizumab in patients with baseline bEOS ≥150 cells/μl using data from the MIRACLE study in Asia. Methods: MIRACLE was a phase Ⅲ clinical trial. From September 7, 2017 to January 30, 2023, patients aged 12-75 years with eosinophilic severe asthma receiving medium- to high-dosage inhaled corticosteroids and long-acting β2 agonists were enrolled from 79 centres in Asia. They were randomized (1∶1) to receive either benralizumab 30 mg or placebo for 48 weeks. The endpoints included annual asthma exacerbation rate (AAER), pre-bronchodilator forced expiratory volume in 1 second (pre-BD FEV1), total asthma symptom score (TASS), St George's Respiratory Questionnaire (SGRQ) score, and the proportion of patients achieving clinical remission (defined as no asthma exacerbations, FEV1 improvement ≥100 ml, and 6-item Asthma Control Questionnaire [ACQ-6 score;≤0.75 or <1.5]; at Weeks 24 and 48) in patients with no baseline oral corticosteroid (OCS) use. Results: Of 695 patients randomized, 598 patients had baseline bEOS ≥150 cells/μl [benralizumab n=301, placebo n=297; age: (50.9±12.1) years; 61.2% were women]. In this population, benralizumab reduced the AAER by 67% [rate ratio (RR)=0.33, 95%CI: 0.25-0.44, P<0.001) and improved lung function [least squares (LS) mean difference vs. placebo: 0.21 L, 95%CI: 0.14-0.29, P<0.001]. Benralizumab achieved greater reductions in TASS (LS mean difference:-0.29, 95%CI:-0.46--0.11, P=0.002) and ACQ-6 scores (LS mean difference:-0.33, 95%CI:-0.46--0.19, P<0.001), and improved SGRQ scores (LS mean difference:-8.07, 95%CI:-11.35--4.79], P<0.001). Among patients with no baseline OCS use (benralizumab n=277; placebo n=264), a higher proportion of benralizumab-treated patients achieved clinical remission at Weeks 24 and 48 compared to the placebo-treated patients. Conclusion: These results reinforce that benralizumab can improve clinical outcomes in patients with severe, uncontrolled asthma with bEOS ≥150 cells/μl in Asia.

Patients undergoing lung transplantation require regular monitoring to ensure that the transplanted lung(s) stay healthy. This is usually achieved through a combination of home spirometry combined with regular reviews in hospital outpatient clinics. Administering questionnaires remotely could reduce the need for regular hospital clinic visits. This study aims to investigate whether a remotely administered questionnaire combined with home spirometry can reduce the number of hospital clinic visits. Patients will be randomised to the intervention arm (questionnaire and home spirometry) or standard of care arm (home spirometry + clinic visit). Quality of life (StGeorge's Respiratory Questionnaire), health economic data and usage acceptability will be collected at the beginning and end of the study period. The primary outcome is to evaluate whether the number of hospital clinic visits are reduced in the intervention arm compared to the control arm. Secondary outcomes will evaluate the intervention influence on healthcare usage, the associated costs of service delivery and its environmental impact. ClinicalTrials.gov NCT05916495.

Rationale: The Undiagnosed COPD and Asthma Population trial showed that early diagnosis and treatment of asthma and chronic obstructive pulmonary disease (COPD) by pulmonologists improved healthcare use, respiratory symptoms, and quality of life. Objectives: To determine if the benefits of early diagnosis and treatment were greater in individuals with more advanced disease or in individuals with asthma as opposed to COPD. We also assessed whether pulmonologist-directed care benefited asthma and COPD subgroups equally. Methods: Case finding was used to identify adults with undiagnosed chronic respiratory symptoms in the community. A total of 508 newly diagnosed participants with COPD or asthma were randomized to receive pulmonologist-care intervention or usual care. Low and high disease burden categories for the St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test were defined using a median-split of baseline scores, and minimal clinically important difference thresholds were used to define significant responses. Benefits of pulmonologist care were assessed by evaluating treatment effects within subgroups and by assessing treatment-by-subgroup interactions. Measurements and Main Results: Patients with higher disease burden at diagnosis were more likely to benefit from early diagnosis and treatment compared with those with lower disease burden. A total of 71% of those with high disease burden showed an improvement in COPD Assessment Test score by ⩾2 points over 12 months compared with 47% with low disease burden (odds ratio, 2.78; 95% confidence interval, 1.90-4.07; P < 0.001). Similar results were seen for SGRQ and FEV1 improvements. In contrast, responses to early diagnosis and treatment were similar for those with asthma versus COPD. Individuals with asthma randomized to undergo pulmonologist-directed care showed greater 1-year improvements in COPD Assessment Test score, SGRQ score, 36-item Short Form score, and FEV1 compared with individuals randomized to receive primary care. However, individuals with COPD experienced similar improvements regardless of whether their treatment was managed by a pulmonologist or primary care provider. Treatment-by-disease interaction terms were not statistically significant. Conclusions: Patients with greater disease burden who exhibited more advanced and symptomatic asthma and COPD at the time of diagnosis benefited more from earlier diagnosis and treatment. Patients with asthma tended to derive greater benefit from pulmonologist-directed care than patients with COPD.

Optimal Exercise Modalities and Doses for Alleviating Dyspnea Symptoms and Enhancing Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Network and Dose-Response Meta-analysis.

Timing of quality of life and lung function changes during the first year following lung transplantation: A multicenter prospective cohort study.

Chronic obstructive pulmonary disease (COPD) is a disease characterized by malnutrition, a catabolic process, and chronic inflammation; thus, vitamin deficiency may occur frequently. We aimed to evaluate the levels of micronutrients in stable COPD patients. There were 168 COPD patients from six pulmonology departments, with 36 healthy controls. The patients also performed pulmonary function tests and filled out the St. George's Respiratory Questionnaire (SGRQ). Serum vitamin B-12 and folate levels were measured using the chemiluminescence immunoassay (CLIA) method. Plasma 25-OH D3 levels were measured by high-performance liquid chromatography (HPLC). Our results revealed vitamin D deficiency in 68.9% (mild: 59.6%, intermediate: 25.7%, severe: 14.7%), vitamin B-12 deficiency in 21.7%, and folic acid deficiency in 50% of COPD patients. There was a significant difference between the COPD and healthy control groups regarding vitamin D deficiency (68.9% vs. 16.6%; p <0.001). Mean plasma 25-OH-D level was significantly lower in COPD patients (p <0.01). There was a positive correlation of plasma 25-OH-D level with the SGRQ impact score (r = 0.174, p = 0.028) and a negative correlation with age and number of exacerbations (respectively; r = -0.248, p = 0.002, and r = -0.160, p = 0.044). Vitamin D, B-12, and folate deficiencies frequently occur in COPD patients. Low plasma levels of 25-OH-D may be associated with advanced age and a higher number of exacerbations in patients with COPD. COPD patients with low vitamin D and folate may experience a decrease in quality of life.

Background:Interstitial lung disease (ILD) leads to progressive lung function decline and significant respiratory symptoms. Although antifibrotic agents preserve lung function and reduce mortality in ILD, their impact on health-related quality of life (HRQoL) remains unclear.Objectives:We aimed to evaluate whether antifibrotic agents improve HRQoL and their effectiveness in treating HRQoL-related symptoms in patients with ILD.Design:Systematic review and meta-analysis.Data sources and methods:A literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library from inception to August 25, 2025. The search included terms related to ILD, antifibrotic agents, and measures of HRQoL. HRQoL outcomes were assessed using the St. George’s Respiratory Questionnaire (SGRQ), including total and domain scores. Data were pooled using a random-effects model, with outcomes reported as mean differences (MD) or relative risks (RR) and heterogeneity evaluated using the I² statistic.Results:A total of 13 randomized controlled trials were included. Antifibrotic agents showed significant improvement in SGRQ scores, particularly in the symptom (MD: −2.59, 95% confidence interval [CI]: −4.56 to −0.61; I² = 32%) and activity (MD: -2.88, 95% CI: –4.82 to –0.94; I² = 34%) domains. Antifibrotics reduced the rate of cough (RR: 0.77, 95% CI: 0.64–0.94; I² = 0%) and dyspnea (RR: 0.71, 95% CI: 0.56 to 0.89; I² = 0%). However, fatigue was frequently observed in patients treated with antifibrotics (RR: 1.48, 95% CI: 1.20–1.83; I² = 0%) compared with the non-antifibrotic group. Most trials were judged to have low-to-moderate risk of bias, and the certainty of evidence was rated very low for total SGRQ scores but low to moderate for domain-specific outcomes and symptoms.Conclusion:Antifibrotic agents may improve HRQoL and reduce dyspnea and cough in patients with ILD, but the certainty of evidence is low, and they may increase fatigue, requiring careful monitoring.Trial registration:The study protocol was registered in PROSPERO (CRD42023450917).

Efficacy of acupuncture-based treatment in Chronic Obstructive Pulmonary Disease - A systematic review and meta-analysis.

This systematic review and meta-analysis evaluate the effects of energy therapies on pulmonary function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC), exercise capacity (6-Minute Walking Test [6MWT]), and quality of life (St George's Respiratory Questionnaire [SGRQ]) in chronic obstructive pulmonary disease (COPD) patients. Conducted per PRISMA guidelines and registered in PROSPERO, this meta-analysis included 8 randomized controlled trials (RCTs) identified through systematic searches of Web of Science, PubMed, Google Scholar, EBSCO, Embase, and Cochrane Library (June 2024-January 2025). Data were analyzed using Comprehensive Meta-Analysis Version 3 software, with heterogeneity and publication bias assessments. Energy therapies significantly improved 6MWT scores (95% CI, P <.05) and SGRQ scores, enhancing quality of life. Patients receiving energy therapy showed increased walking distance, particularly when combined with pulmonary rehabilitation. SGRQ results indicated better quality of life, mainly due to reduced stress and anxiety. However, no significant improvement was found in FEV1, FVC, or FEV1/FVC values (P >0.05), suggesting limited direct effects on pulmonary function. Methodological variations and sample size differences contributed to result inconsistencies. Energy therapies may complement COPD treatment by improving exercise capacity and quality of life. However, large-scale, long-term RCTs are needed to clarify their impact on pulmonary function.

Up to 40% of patients with chronic obstructive pulmonary disease (COPD) exhibit elevated blood eosinophils, reflective of type 2 inflammation. Dupilumab and mepolizumab versus standard of care have demonstrated moderate-to-severe exacerbation reductions of 30-34% and 15-18%, respectively, over 52weeks. This study compared their relative efficacy using indirect treatment comparison (ITC). A Bucher ITC was performed on 52-week phase 3 trials of dupilumab (BOREAS/NOTUS) and mepolizumab (MATINEE/METREX/METREO). The primary ITC endpoint was annualized moderate-to-severe exacerbation rates in patients from BOREAS + NOTUS versus MATINEE + METREX (modified intention-to-treat high stratum cohort, representing an eosinophilic phenotype); sensitivity analyses were performed using different combinations of mepolizumab data including MATINEE + METREX + METREO (100-mg arm). Other 52-week endpoints included mean difference in pre-bronchodilator forced expiratory volume in 1s (FEV1), proportion of St. George's Respiratory Questionnaire (SGRQ) improvement ≥ 4 points, proportion of Evaluating Respiratory Symptoms in COPD (E-RS:COPD) improvement ≥ 2 points, and annualized severe exacerbation rate. Rate ratios (RRs)/odds ratios (ORs) with 95% confidence intervals (CIs) are reported. The primary ITC resulted in an RR of 0.82 (95% CI 0.66, 1.01), showing a numerical advantage for dupilumab versus mepolizumab in reducing moderate-to-severe exacerbation. Sensitivity analyses confirmed findings from the primary ITC (BOREAS + NOTUS vs. MATINEE + METREX + METREO: RR 0.83 [95% CI 0.68, 1.01]). Dupilumab demonstrated significantly greater FEV1 improvement (mean difference 83.4mL [95% CI 36.1, 130.7]) and proportion of E-RS:COPD improvement ≥ 2 points (OR 1.71; [95% CI 1.18, 2.48]), with a numerical difference favoring dupilumab for the proportion of SGRQ improvement ≥ 4 points (OR 1.16; [95% CI 0.86, 1.56]) and for annualized severe exacerbation rate (RR 0.61 [95% CI 0.33, 1.13]) versus mepolizumab. This ITC suggests potential clinical benefits of dupilumab over mepolizumab in reducing exacerbations and improving lung function, respiratory symptoms, and quality of life in patients with COPD and type 2 inflammation. Direct head-to-head trials are necessary to confirm these results and better guide treatment choices.

Introduction: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition caused by SERPINA1 variants with variable severity. Current international guidelines do not recommend augmentation therapy for intermediate AATD; nevertheless, some patients show clinically severe phenotypes in real-world practice. We aimed to evaluate, in an exploratory manner, the potential effects of augmentation therapy on exacerbations, quality of life, and lung function in this subgroup. Methods: In this multicenter retrospective study, we included 27 heterozygous patients with intermediate AATD (serum AAT 50–110 mg/dL), Chronic Obstructive Pulmonary Disease (COPD), and/or emphysema. Clinical phenotypes included emphysema-predominant disease, COPD with frequent exacerbations, and overlap with bronchiectasis/asthma; HRCT patterns were recorded. We assessed the annual number of exacerbations (moderate: steroids/antibiotics; severe: hospitalization/including pneumothorax), St. George’s Respiratory Questionnaire (SGRQ), and lung function before and after 12 months of therapy. Results: Augmentation therapy was associated with a reduction in annual exacerbations from a median (IQR) of 2 (1.5–3) to 1 (0–1) (p < 0.0001) and an improvement in SGRQ total score (58.89 ± 16.83 to 48.34 ± 21.20; p = 0.0039). The mean SGRQ change exceeded the 4-point MCID for COPD. No significant changes were observed in spirometry or Diffusing Capacity of the Lung for Carbon Monoxide (DLCO). Conclusions: These exploratory findings suggest that augmentation therapy may reduce exacerbations and improve quality of life in selected patients with intermediate AATD and COPD/emphysema. Given the retrospective design, small sample, and lack of a control group, the results should be interpreted as hypothesis-generating and warrant confirmation in prospective studies.

Alpha-1 antitrypsin deficiency (AATD) is a rare genetic disorder associated with early-onset chronic obstructive pulmonary disease and impaired quality of life (QoL). This retrospective study evaluated the impact of pulmonary rehabilitation (PR) on QoL using repeated St George's Respiratory Questionnaire (SGRQ) scores. Among 274 patients, PR participants had more severe disease but showed no greater QoL improvement over time. Dyspnoea and exacerbation frequency were the strongest predictors of poorer outcomes. PR was not associated with significantly improved SGRQ trajectories. These findings highlight the need for personalised, disease-specific rehabilitation strategies in AATD to address limitations of conventional PR programmes in this population.

IntroductionThe S3-Noninvasive Ventilation (S3-NIV) questionnaire is a simple tool that allows monitoring of symptoms and side-effects in individuals using home mechanical ventilation (HMV). Its longitudinal use in monitorisation is complicated by the current absence of a minimal clinically important difference (MCID), which could facilitate the application of a more tailored follow-up and therapy optimisation. We aimed to establish the MCID for the S3-NIV in people with COPD under HMV.MethodsWe conducted an observational study with adult individuals with COPD treated with HMV, followed in an HMV outpatient clinic. The S3-NIV, the Severe Respiratory Insufficiency (SRI) questionnaire and the St George's Respiratory Questionnaire (SGRQ) were applied at baseline and after a 6-month period. Demographic and clinical data were collected from hospital records. The MCID was computed using both distribution- and anchor-based methods. The pooled MCID was computed using the weighted mean (two-thirds anchor- and one-third distribution-based methods).ResultsA total of 99 participants (71% male) were included, with a mean±sd age of 72±9 years and a median (interquartile range (IQR)) forced expiratory volume in 1 s of 37 (29–49)% predicted. Median time under HMV was 40 (IQR 24–84) months. The SRI (r=0.311, p=0.002) and the SGRQ (r= −0.334, p=0.001) questionnaires were correlated with S3-NIV, and therefore were used as anchors. Our pooled analysis resulted in a MCID of 0.8 points.ConclusionA MCID of 0.8 points in the S3-NIV questionnaire is proposed in stable individuals with COPD using HMV, supporting the identification of clinically significant changes and management improvement.