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A Symptom-Based Measure of the Severity of Chronic Lung Disease : Results From the Veterans Health Study

Alfredo J. Selim; Xinhua S. Ren; Graeme Fincke; William Rogers; Austin Lee; Lewis Kazis
Author and Funding Information

Affiliations: From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Section of General Internal Medicine, Boston University School of Medicine and Boston VA Medical Center,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center; and Harvard Harvard School of Public Health, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Department of Mathematics, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the School of Public Health and Medicine, Boston University

Affiliations: From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Section of General Internal Medicine, Boston University School of Medicine and Boston VA Medical Center,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center; and Harvard Harvard School of Public Health, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Department of Mathematics, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the School of Public Health and Medicine, Boston University

Affiliations: From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Section of General Internal Medicine, Boston University School of Medicine and Boston VA Medical Center,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center; and Harvard Harvard School of Public Health, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Department of Mathematics, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the School of Public Health and Medicine, Boston University

Affiliations: From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Section of General Internal Medicine, Boston University School of Medicine and Boston VA Medical Center,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center; and Harvard Harvard School of Public Health, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Department of Mathematics, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the School of Public Health and Medicine, Boston University

Affiliations: From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Section of General Internal Medicine, Boston University School of Medicine and Boston VA Medical Center,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center; and Harvard Harvard School of Public Health, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and The Health Institute, New England Medical Center, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the Department of Mathematics, Boston University,  From the Center for Health Quality, Outcomes, and Economic Research, Bedford Health Services Research and Development Field Program, VA Medical Center, Bedford, Mass; and the School of Public Health and Medicine, Boston University


1997 by the American College of Chest Physicians


Chest. 1997;111(6):1607-1614. doi:10.1378/chest.111.6.1607
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Published online

Abstract

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.


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