Pulmonary rehabilitation in chronic respiratory insufficiency. 7. Health-related quality of life among patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in industrialised nations. It is essentially incurable and, for many, inexorably progressive; health care providers spend much effort trying to minimise patients' symptoms and to improve their ability to function in dayto-day life. While improved survival time is an important aim of treatment, there is growing recognition that improving the quantity of an individual's life may not be the only goal; for some, improving the quality of life may be far more important. Since reducing symptoms, increasing function, and improving the quality of life are central therapeutic goals for patients with COPD, as for many chronic diseases, it is important for researchers and clinicians to develop a common understanding of what is meant by these phrases and how these concepts can be measured. In the past 10 years there has been an increasing body of literature on measurement of quality of life in patients with COPD and, more recently, on the efficacy of therapeutic agents based on quality of life measures. Studies measuring the quality of life in these patients appeared in the mid 1980s'4 when quality of life measures were used to assess continuous oxygen therapy,' intermittent positive pressure breathing,6 and, more recently, in the assessment of theophylline,7 inhaled bronchodilators,8 home respiratory nursing care,9 and pulmonary rehabilitation programmes.'0 As this trend continues it is important for clinicians to understand and assess these measures to help decide whether a new treatment is valuable. We will review quality of life measures in patients with COPD with the emphasis on issues important to the clinician who seeks an understanding of quality of life measures as they are used in therapeutic trials.

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