COSMIN database

The validity of health-related quality of life questionnaires in bronchiectasis: a systematic review and meta-analysis

Spinou, A., Fragkos, K. C., Lee, K. K., Elston, C., Siegert, R. J., Loebinger, M. R., Wilson, R., Garrod, R., and Birring, S. S.
BACKGROUND: A range of questionnaires have been used to assess health-related quality of life (HRQOL) in bronchiectasis. A systematic review was conducted to evaluate their psychometric properties and assess associations between HRQOL and clinical measures.

METHODS: Five electronic databases were searched. Studies eligible for inclusion were those that investigated the validity of HRQOL questionnaires and/or their association with other outcomes in adults with bronchiectasis. Patients with cystic fibrosis were excluded. The identified questionnaires were assessed for convergent, discriminant and cross-cultural translation validity; missing data, floor and ceiling effects, internal consistency, responsiveness and test-retest reliability. A meta-analysis was conducted to estimate the strength of associations between HRQOL and clinical measures.

RESULTS: From 1918 studies identified, 43 studies were included in the systematic review, of which 38 were suitable for the meta-analysis. Nine HRQOL questionnaires were identified, with the most widely used being: St George's Respiratory Questionnaire, Leicester Cough Questionnaire, Quality of Life-Bronchiectasis and Short Form-36. HRQOL questionnaires had moderate to good internal consistency and good test-retest reliability. Only 8 of 18 studies that used translated HRQOL questionnaires reported or referred to the validity of the translated questionnaire. There was a stronger correlation (mean r (95% CI)) between HRQOL and subjective outcome measures, such as dyspnoea (0.55 (0.41 to 0.68)) and fatigue (0.42 (0.23 to 0.58)) compared with objective measures; exercise capacity (-0.41 (-0.54 to -0.24)), FEV1% predicted (-0.31 (-0.40 to -0.23)) and extent of bronchiectasis on CT scan (0.35 (0.03 to 0.61)); all p<0.001.

CONCLUSIONS: This review supports most HRQOL questionnaires used in bronchiectasis have good psychometric properties. There was a weak to moderate association between HRQOL and objective outcome measures. This suggests that HRQOL questionnaires assess a unique aspect of health not captured by objective measures.
Publication year:
General health perceptions / HRQoL:
Health-related quality of life
Adults (18-65)
Diseases of and symptoms related to the respiratory system
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
CAT - COPD Assessment Test   
CQLQ - Cough Quality of Life Questionnaire [alias: Cough-specific Quality of Life Questionnaire]
CRDQ - Chronic Respiratory Disease Questionnaire [alias: CRQ]   
EQ-5D - EuroQoL-5 Dimensions   
EQ-VAS - EuroQol Visual Analogue Scale
LCQ - Leicester Cough Questionnaire
QOL-B - Quality of Life - Bronchiectasis
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SGRQ - St. George's Respiratory Questionnaire   
SNOT-20 - 20-Item Sino-Nasal Outcome Test