Health-related quality of life assessment in chronic pulmonary aspergillosis: a systematic review

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Background: Chronic Pulmonary Aspergillosis (CPA) is a progressive fungal lung infection with a significant burden on health status and quality of life. Health-related quality of life (HRQoL) tools can help inform clinical decision-making and be used as therapeutic endpoints. Aim: Analyse the psychometric properties of existing HRQoL tools and symptom scores in CPA. Method: A systematic review was conducted to retrieve published studies reporting HRQoL tools or symptom scores in CPA between 2003-24. Results: 35 eligible studies were identified. Generic HRQoL tools were used in particular the St George’s Respiratory Questionnaire (SGRQ) (n=18) with no disease-specific tools reported. 1 study established the validity and reliability of SGRQ in CPA, evaluating internal consistency using Cronbach’s alpha, convergent validity through correlation with other generic HRQoL tools and minimal clinically important difference (MID) using patient-reported visual analogue scales (VAS) for global well-being. 17 studies identified CPA-specific symptoms including haemoptysis, cough, dyspnoea, fever and weight loss. SGRQ content validity assessed against these symptoms revealed significant domain omission with complexity additionally impacting usability. 1 study used a 6-item Respiratory Symptom Score (RSS) assessed using VAS developed through expert consensus with no studies however evaluating the validity or psychometric properties. Conclusion: There is a lack of well-validated disease-specific HRQoL tools in CPA with currently used tools either having significant content omission or minimal assessment of psychometric validity. This highlights the need for a robust, validated CPA-specific HRQoL tool.

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