Methods: The major domains of HRQoL and functioning impacted by COPD were identified from the literature, and submitted to patient review during 10 face-to-face interviews in France. The resulting Visual Simplified Respiratory Questionnaire (VSRQ) in French language was completed by 636 COPD patients (mean age 64 years, 85% men) alongside a clinical trial conducted in France at baseline and after 9 months. The dimensionality of the VSRQ was assessed by Principal Components Analysis (PCA) with Varimax rotation. Internal consistency reliability was assessed by Cronbach's alpha. Clinical validity was assessed by comparison to Physicians Global Assessment. Spearman correlation coefficients were calculated to assess concurrent validity with St'Georges Respiratory Questionnaire (SGRQ). Intra Class Correlation (ICC) coefficients were calculated to assess test-retest reliability in stable patients. Effect Sizes were calculated to investigate responsiveness to change over time in clinically improved patients. The Minimal Important Difference (MID) was calculated.

Results: Concepts identified from the literature were selected and reworded after patients interviews, and formatted as Visual Analogue Scales. The VSRQ includes 8 items, covering dyspnea, anxiety, depression, quality of sleep, energy, daily activities, social activities, sexual life. A global variance greater than 40% on first PCA factor allowed the calculation of a global score ranging from 0 (poor HRQoL) to 80 (Excellent HRQoL). Cronbach's alpha was satisfactory for group comparisons (0.84). Clinical validity was shown. Correlation with SGRQ total score was -0.70, showing good concurrent validity. Test-retest reliability was good (ICC=0.77). The VSRQ score was responsive to change over time. The MID was 3.4.

Conclusions: The VSRQ demonstrated satisfying cross-sectional and longitudinal psychometric properties. Its brevity and comprehensiveness makes it a good candidate for administration in clinical practice. Further validation in clinical practice will be needed.