Tuberc Respir Dis.  2008 Sep;65(3):183-190.

Health-related Quality of Life Measurement with St. George's Respiratory Questionnaire in Post-tuberculous Destroyed Lung

• Lee BH
• Kim YS
• Lee KD
• Lee JH
• Kim SH

Abstract

BACKGROUND: The control of active pulmonary tuberculosis is still an issue in community medicine. But there are also considerable needs for supportive management of symptomatic patients with post-tuberculous destroyed lung. Few studies have evaluated clinical characteristics and health-related quality of life in patients with post-tuberculous destroyed lung.
METHODS
We evaluated lung function, exercise tolerance, HRCT and health-related quality of life measurements using the Korean version of St. George's Respiratory Questionnaire (SGRQ) in 22 patients with parenchymal damage to more than a half of one lung due to pulmonary tuberculosis.
RESULTS
In the pulmonary function test, mixed defects and obstructive defects were observed in 10 (45.0%) and 9 (40.9%) of patients, respectively. In the cardiopulmonary exercise test, the mean VO2max% predicted (39.0%+/-10.9%) and O2 pulse% predicted (61.3%+/-13.6%) were markedly decreased. In the SGRQ, the impact score (mean 27.8+/-18.5) was significantly lower than the symptom score (mean 53.9+/-20.9) or activity score (mean 50.8+/-27.3) (p<0.05, p<0.01). Cronbach's alpha coefficient value for reliability was more than 0.7 for each subscale and total score. The total score showed a significant negative correlation with FEV1% predicted (r=-0.46, p<0.05) and SaO2 (r=-0.60, p<0.05). On HRCT, a median of 9 (range 5~15) bronchopulmonary segments were destroyed by less than half, which significantly correlated with SGRQ total score (r=-0.52, p=0.02).
CONCLUSION
The reliability and validity of the Korean version of the SGRQ was acceptable for the measurement of health-related quality of life in patients with post-tuberculous destroyed lung.

Keyword

Tuberculosis; Quality of life; Pulmonary function test

MeSH Terms

Community Medicine
Exercise Test
Exercise Tolerance
Humans
Lung
Quality of Life
Surveys and Questionnaires
Reproducibility of Results
Respiratory Function Tests
Tuberculosis
Tuberculosis, Pulmonary

Figure

• 

  Figure 1 Types of ventilatory function defect (A). Severity of ventilatory function defect (B). Severity classification according to FEV1% predicted; mild (>70%), moderate (60~69%), moderately severe (50~59%), severe (35~49%), and very severe (<35%).

• 

  Figure 2 Correlation between total score of Korean version of SGRQ and FEV1% predicted (A), SaO2 (B), and reserved segments on HRCT (C). *number of bronchopulmonary segments that were destroyed by less than half on HRCT. SGRQ: St. George's Respiratory Questionnaire; HRCT: high resolution computed tomography.

Reference

1. Han SG. Pathophysiology of pulmonary tuberculosis. Respiratory diseases. 2004. Seoul: Koonja;831–834.

2. Ellner JJ. The immune response in human tuberculosis: implications for tuberculosis control. J Infect Dis. 1997. 176:1351–1359.

3. Leung AN. Pulmonary tuberculosis: the essentials. Radiology. 1999. 210:307–322.

4. Miller WT, Miller WT Jr. Tuberculosis in the normal host: radiological findings. Semin Roentgenol. 1993. 28:109–118.

5. Prigatano GP, Wright EC, Levin D. Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease. Arch Intern Med. 1984. 144:1613–1619.

6. Juniper EF, Johnston PR, Borkhoff CM, Guyatt GH, Boulet LP, Haukioja A. Quality of life in asthma clinical trials: comparison of salmeterol and salbutamol. Am J Respir Crit Care Med. 1995. 151:66–70.

7. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation: the St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992. 145:1321–1327.

8. Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respir Med. 1991. 85:Suppl B. 25–31.

9. Kim YS, Byun MK, Jung WY, Jeong JH, Choi SB, Kang SM, et al. Validation of the Korean version of the St. George's Respiratory Questionnaire for patients with chronic respiratory disease. Tuberc Respir Dis. 2006. 61:121–128.

10. Lee JH, Chang JH. Lung function in patients with chronic airflow obstruction due to tuberculous destroyed lung. Respir Med. 2003. 97:1237–1242.

11. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005. 26:948–968.

12. Long R, Maycher B, Dhar A, Manfreda J, Hershfield E, Anthonisen N. Pulmonary tuberculosis treated with directly observed therapy: serial changes in lung structure and function. Chest. 1998. 113:933–943.

13. Curtis JR, Deyo RA, Hudson LD. Pulmonary rehabilitation in chronic respiratory insufficiency: health- related quality of life among patients with chronic obstructive pulmonary disease. Thorax. 1994. 49:162–170.

14. Curtis JR, Martin DP, Martin TR. Patient-assessed health outcomes in chronic lung disease: what are they, how do they help us, and where do we go from here? Am J Respir Crit Care Med. 1997. 156:1032–1039.

15. Wilson CB, Jones PW, O'Leary CJ, Cole PJ, Wilson R. Validation of the St. George's Respiratory Questionnaire in bronchiectasis. Am J Respir Crit Care Med. 1997. 156:536–541.

16. Spencer S, Jones PW. Time course of recovery of health status following an infective exacerbation of chronic bronchitis. Thorax. 2003. 58:589–593.

17. Grossman R, Mukherjee J, Vaughan D, Eastwood C, Cook R, LaForge J, et al. A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis: the Canadian Ciprofloxacin Health Economic Study Group. Chest. 1998. 113:131–141.

18. Osman IM, Godden DJ, Friend JA, Legge JS, Douglas JG. Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax. 1997. 52:67–71.

19. Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Thoracic sequelae and complications of tuberculosis. Radiographics. 2001. 21:839–858.

20. Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S, et al. Pulmonary impairment after tuberculosis. Chest. 2007. 131:1817–1824.

21. Hnizdo E, Singh T, Churchyard G. Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. Thorax. 2000. 55:32–38.

22. Snider GL, Doctor L, Demas TA, Shaw AR. Obstructive airway disease in patients with treated pulmonary tuberculosis. Am Rev Respir Dis. 1971. 103:625–640.

23. Willcox PA, Ferguson AD. Chronic obstructive airways disease following treated pulmonary tuberculosis. Respir Med. 1989. 83:195–198.

24. Khan FA, Rehman M, Marcus P, Azueta V. Pulmonary gangrene occurring as a complication of pulmonary tuberculosis. Chest. 1980. 77:76–80.

25. Palmer PE. Pulmonary tuberculosis: usual and unusual radiographic presentations. Semin Roentgenol. 1979. 14:204–243.