Chest
Volume 116, Issue 5, November 1999, Pages 1175-1182
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Clinical Investigations
DIFFUSE LUNG DISEASE
Assessment of Health-Related Quality of Life in Patients With Interstitial Lung Disease

https://doi.org/10.1378/chest.116.5.1175Get rights and content

Study objectives

Health-related quality of life associated with interstitial lung disease has received little attention in clinical studies because there have been no validated methods for directly measuring it. We have assessed the validity of several generic and respiratory-specific quality-of-life instruments in patients with interstitial lung disease.

Design

Cross-sectional study.

Setting

Outpatient pulmonary clinic at a university referral center.

Patients

Fifty patients with interstitial disease such as idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis, and asbestosis.

Interventions

Patients were administered four quality-of-life questionnaires, the Medical Outcomes Study Short Form 36 (SF-36), the Quality of Well-being scale (QWB), the Chronic Respiratory Questionnaire (CRQ), and the St. George's Respiratory Questionnaire (SGRQ). Patients concomitantly underwent pulmonary function testing and performed a 6-min walk.

Measurements and results

Validation of these instruments was based on testing an a priori hypothesis that worse quality-of-life scores should correlate with more severe physiologic impairment demonstrated by pulmonary function tests, exercise tolerance on the 6-min walk, and dyspnea scores. Our patients, on average, had a moderate degree of physiologic impairment and demonstrated moderately decreased quality-of-life scores. Scores from all four quality-of-life questionnaires correlated significantly with 6-min walk distance and dyspnea score. Scores from the SF-36, QWB, and SGRQ showed significant correlation with FVC, FEV1, and diffusing capacity as well. The SF-36 and SGRQ consistently showed the strongest correlation with physical impairment.

Conclusions

Our findings indicate that preexisting quality-of-life instruments can be applied to patients with interstitial lung disease and suggest that the SF-36 and the SGRQ, in particular, are sensitive tools for assessing quality of life in these patients. Future intervention studies of patients with interstitial lung disease should consider using these measures.

Section snippets

Patients

All patients with documented interstitial lung disease referred to or followed by the University of Washington Chest Clinic from September 1997 through July 1998 were identified by screening clinic appointment books and were asked to participate if they met entry criteria. Interstitial lung disease was defined by the clinical presentation of otherwise unexplained dyspnea in conjunction with (1) linear or reticulonodular interstitial infiltrates on chest radiograph or CT scan, and (2)

Clinical Characteristics

We administered quality-of-life questionnaires to 50 patients with interstitial lung disease. The clinical characteristics of this group are described in Table 1. The median age of the patients was 60.5 years with a range from 29 to 81 years. The older age and male predominance of the study population reflect the epidemiologic features of its largest group, idiopathic pulmonary fibrosis.

The majority of patients were currently taking or had been previously taking steroids and other

Discussion

Health-related quality of life in interstitial lung disease is a vital concern to both patients and their physicians. Patients experience decreased quality of life because of symptoms and treatment side effects as well as the progressive nature of the respiratory impairment and functional limitation caused by the disease. Physicians should be particularly concerned about quality-of-life issues with these diseases because medications currently available are of marginal effectiveness,

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    Supported in part by the Respiratory Research Training grant, No. 5 T32HL07287. Additional project support was provided by the Firland Sheltered Workshop Foundation, a nonprofit agency with a mission ofsupport for projects relating to care of individuals with tuberculosisand other chronic respiratory problems.

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