FIG. 3:  A principal feature of pulmonary rehabilitation is its effectiveness on health-related quality of life (HRQOL).  One way to determine this is to ask our patients how they are doing.  In a clinical setting it is useful to ask, “How do you feel?”  Scientifically, however, this requires a validated questionnaire that purportedly measures HRQOL, and there are several of these for patients with COPD. One of these is the St. George’s Respiratory Questionnaire (SGRQ), which has three components: symptoms, activities, and impacts.^[1]  Figures 3 and 4 represent the combined results of a study by Vincken et al, which compared the effects of 2 anticholinergic bronchodilator drugs in patients with COPD,^[2] and a pulmonary rehabilitation intervention study carried out at my hospital.^[3]  The Figure does not display quantitative scientific results, but is for illustrative purposes only. 

The SGRQ uses a scale of 0 to 100, with 0 being perfect HRQOL (which no one has) and 100 being a miserable health-related HRQOL (which very few have).^[1]  This means that a fall in a patient’s SGRQ score corresponds to an improvement in HRQOL and in the effect of COPD for that individual (ie, how much the disease, its symptoms and its functional status limitation, affect the individual). 

In this illustration,^[2] the mean pretreatment SGRQ impact score was about 55, at the base of the black box in the Figure Then the patients were given a good, long-acting bronchodilator, and by the end of treatment, their HRQOL had improved by about 4 units, as shown here.  In this study that equated to a statistically significant and close to clinically meaningful improvement in the SGRQ. 

Even after optimal bronchodilator therapy such as administered in this study, however, there may still be need for further improvement.  Thus even after the optimal bronchodilator therapy administered in this study the SGRQ was still a bit over 50 – which illustrates the good and the bad of COPD therapy.  The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines state that COPD is “a preventable and treatable disease,”^[4] and the results illustrated from this study confirm that, but it is not completely treatable with drugs such as a long-acting bronchodilator.