A symptom-based measure of the severity of chronic lung disease: results from the Veterans Health Study

Chest. 1997 Jun;111(6):1607-14. doi: 10.1378/chest.111.6.1607.


Study objectives: We developed a symptom-based measure of severity for chronic lung disease (CLD) that can be readily administered in ambulatory care settings and be used to supplement general health-related quality of life (HRQoL) assessments and pathophysiologic indicators in research and clinical care.

Design: Cross-sectional data from the Veterans Health Study, an observational study of health outcomes in patients receiving Veterans Affairs (VA) ambulatory care.

Setting: Four VA outpatient clinics.

Study subjects: Two hundred ninety-two participants with CLD were identified on the basis of patient report of having a physician's diagnosis of chronic bronchitis, emphysema, or asthma and either using inhaled medications or having a productive cough on most days for 3 months.

Measurements and results: Participants were scheduled for an in-person interview in which they completed a CLD questionnaire and measurements of peak expiratory flow rate (PEFR). They were also mailed an HRQoL questionnaire, the Short Form Health Survey (SF-36). The CLD questionnaire included six symptom items chosen by an expert panel (two items each for dyspnea, wheezing, and productive cough). The combination of these items yielded a CLD severity index that correlated significantly with all eight scales of the SF-36 (range of r, -0.19 to -0.37; p<0.01). In contrast, PEFR had statistically significant correlations only with two SF-36 scales: physical functioning and bodily pain.

Conclusions: The CLD severity index is a reliable and valid patient-administered instrument that may be used to evaluate the effects of CLD on general HRQoL and predict future health services utilization.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Boston
  • Chronic Disease
  • Cross-Sectional Studies
  • Hospitals, Veterans
  • Humans
  • Least-Squares Analysis
  • Lung Diseases / diagnosis*
  • Male
  • Middle Aged
  • Outpatient Clinics, Hospital
  • Prospective Studies
  • Quality of Life
  • Reproducibility of Results
  • Severity of Illness Index*
  • Surveys and Questionnaires