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MeiLan K. Han, MD; Marilyn G. Foreman, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Han), University of Michigan; and Pulmonary and Critical Care Medicine (Dr Foreman), Morehouse School of Medicine.

Correspondence to: MeiLan K. Han, MD, Division of Pulmonary and Critical Care Medicine, University of Michigan, 1500 E Medical Dr, 3916 Taubman Center, Ann Arbor, MI 48109; e-mail: mrking@umich.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Han has participated on advisory boards for Boehringer Ingelheim GmbH, Pfizer, GlaxoSmithKline, Genentech, Novartis, and Medimmune. She has participated on speakers’ bureaus for Boehringer Ingelheim GmbH, Pfizer, GlaxoSmithKline, the National Association for Continuing Education, and WebMD. She has consulted for Novartis and Nycomed, and has received royalties from UpToDate and ePocrates, Inc. Dr Foreman has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):571. doi:10.1378/chest.11-2539
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To the Editor:

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.

Han MK, Curran-Everett D, Dransfield MT, et al; and the COPD Gene Investigators and the COPD Gene Investigators Racial differences in quality of life in patients with COPD. Chest. 2011;1405:1169-1176 [PubMed] [CrossRef]
 
Jones PW, Anderson JA, Calverley PM, et al; TORCH investigators TORCH investigators Health status in the TORCH study of COPD: treatment efficacy and other determinants of change. Respir Res. 2011;12:71 [PubMed]
 

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Han MK, Curran-Everett D, Dransfield MT, et al; and the COPD Gene Investigators and the COPD Gene Investigators Racial differences in quality of life in patients with COPD. Chest. 2011;1405:1169-1176 [PubMed] [CrossRef]
 
Jones PW, Anderson JA, Calverley PM, et al; TORCH investigators TORCH investigators Health status in the TORCH study of COPD: treatment efficacy and other determinants of change. Respir Res. 2011;12:71 [PubMed]
 
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