• Jeffrey J Swigris, Hye-Seung Lee, Marsha Cohen, Yoshikazu Inoue, Joel Moss, Lianne G Singer, Lisa R Young, Francis X McCormack, and National Institutes of Health Rare Lung Diseases Consortium and the Multicenter International Lymphangioleiomyomatosis Efficacy and Safety of Sirolimus Trial Group.
• Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO. Electronic address: swigrisj@njc.org.
• Chest. 2013 Jun 1; 143 (6): 1671-1678.

BackgroundLymphangioleiomyomatosis (LAM) is an uncommon, progressive, cystic lung disease that causes shortness of breath, hypoxemia, and impaired health-related quality of life (HRQL). Whether St. George's Respiratory Questionnaire (SGRQ), a respiratory-specific HRQL instrument, captures longitudinal changes in HRQL in patients with LAM is unknown.MethodsUsing data from the Multicenter International Lymphangioleiomyomatosis Efficacy and Safety of Sirolimus trial, we performed analyses to examine associations between SGRQ scores and values for four external measures (anchors). Anchors included (1) FEV₁, (2) diffusing capacity of the lung for carbon monoxide, (3) distance walked during the 6-min walk test, and (4) serum vascular endothelial growth factor-D.ResultsSGRQ scores correlated with the majority of anchor values at baseline, 6 months, and 12 months. Results from longitudinal analyses demonstrated that SGRQ change scores tracked changes over time in values for each of the four anchors. At 12 months, subjects with the greatest improvement from baseline in FEV₁ experienced the greatest improvement in SGRQ scores (Symptoms domain, -13.4 ± 14.6 points; Activity domain, -6.46 ± 8.20 points; Impacts domain, -6.25 ± 12.8 points; SGRQ total, -7.53 ± 10.0 points). Plots of cumulative distribution functions further supported the longitudinal validity of the SGRQ in LAM.ConclusionsIn LAM, SGRQ scores are associated with variables used to assess LAM severity. The SGRQ is sensitive to change in LAM severity, particularly when change is defined by FEV₁, perhaps the most clinically relevant and prognostically important variable in LAM. The constellation of results here supports the validity of the SGRQ as capable of assessing longitudinal change in HRQL in LAM.

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