Validation of the Bronchiectasis Health Questionnaire in Bronchiectasis and Estimation of the Meaningful Score Difference for ABPA.

Abstract

The Bronchiectasis Health Questionnaire (BHQ) is a validated tool for assessing health-related quality of life in bronchiectasis. Its psychometric performance and meaningful score difference (MSD) have not been evaluated in allergic bronchopulmonary aspergillosis (ABPA). To evaluate the psychometric properties of the BHQ in bronchiectasis and estimate the MSD in subjects with ABPA. Thirty subjects with bronchiectasis (cohort 1, 83% ABPA) completed the BHQ and Saint George's Respiratory Questionnaire at baseline and after 14 days to assess acceptability, validity, internal consistency, and test-retest reliability. For MSD estimation, 72 treatment-naive subjects with ABPA (cohort 2) were assessed before and 2 months after oral prednisolone therapy. Clinical measures included BHQ scores, modified Medical Research Council grade, visual analogue scale for dyspnea, spirometry, total IgE levels, chest radiographs, and subjective global assessment. Only anchors with correlation greater than or equal to 0.30 with BHQ change were used for MSD estimation through linear regression, receiver-operating characteristic-curve analysis, and t test, supported by distribution-based methods. The BHQ demonstrated acceptability, strong correlation with Saint George's Respiratory Questionnaire (r = -0.80), good internal consistency (Cronbach α = 0.81), and test-retest reliability (intraclass correlation coefficient = 0.81). Item analysis showed 9 of 10 items with adequate item-total correlations (r = 0.43-0.80). Only modified Medical Research Council and visual analogue scale correlations met anchor thresholds. The BHQ scores improved significantly (mean, 57 to 72; P < .001) after treatment. MSD estimates across anchor-based methods ranged from 7.2 to 14.5 points; triangulation yielded an estimate of 10 points. The BHQ showed acceptable preliminary psychometric properties in predominantly ABPA-associated bronchiectasis. The MSD estimate for patients with ABPA is 10 points, though comprehensive multicenter validation is needed to confirm these findings.