We thank Dr Loh for his interest in our recent article in CHEST.1 It is very interesting to see similar associations among race, education, and quality of life in asthma in a different patient population. As Dr Loh points out, cultural and socioeconomic factors do appear to influence the “experience” of this disease. He also raises a concern regarding the reliability and interpretability of quality-of-life assessments, such as the St. George Respiratory Questionnaire (SGRQ), across different cultures. The SGRQ has been used around the world in > 100 languages. A recent study published by Paul Jones, developer of the SGRQ, examined the SGRQ data from TORCH (Towards a Revolution in COPD Health) in nearly 5,000 patients from 28 countries.2 The relationship between change in FEV1 and SGRQ did not differ by world region, although patients in the Asia-Pacific region showed improvements in quality of life even in the placebo group. This may be due to a “trial effect,” in which patients in the study received better health care by joining a clinical trial. Hence, although there are currently no data clearly supporting the possibility that the SGRQ itself behaves differently in different races and cultures, differences in health-care systems certainly may influence scores.