Background: Respiratory symptoms are common in the general population, and their presence is related to Health-related quality of life (HRQoL). The objective was to describe the association of respiratory symptoms with HRQoL in subjects with and without asthma or COPD and to investigate the role of atopy, bronchial hyperresponsiveness (BHR), and lung function in HRQoL. Methods: The European Community Respiratory Health Survey (ECRHS) I and II provided data on HRQoL, lung function, respiratory symptoms, asthma, atopy, and BHR from 6009 subjects. Generic HRQoL was assessed through the physical component summary (PCS) score and the mental component summary (MCS) score of the SF-36. Factor analyses and linear regressions adjusted for age, gender, smoking, occupation, BMI, comorbidity, and study centre were conducted. Results: Having breathlessness at rest in ECRHS II was associated with mean score (95% CI) impairment in PCS of -8.05 (-11.18, -4.93). Impairment in MCS score in subjects waking up with chest tightness was -4.02 (-5.51, -2.52). The magnitude of HRQoL impairment associated with respiratory symptoms was similar for subjects with and without asthma/COPD. Adjustments for atopy, BHR, and lung function did not explain the association of respiratory symptoms and HRQoL in subjects without asthma and/or COPD. Conclusion: Subjects with respiratory symptoms had poorer HRQoL; including subjects without a diagnosis of asthma or COPD. These findings suggest that respiratory symptoms in the absence of a medical diagnosis of asthma or COPD are by no means trivial, and that clarifying the nature and natural history of respiratory symptoms is a relevant challenge.

The coordination of ECRHS II was supported by the European Commission, as part of their Quality of Life programme. The following bodies funded the local studies in ECRHS II in this article. Albacete--Fondo de Investigaciones Santarias (grant code: 97/0035-01, 13 99/0034-01, and 99/0034-02), Hospital Universitario de Albacete, Consejeria de Sanidad. Antwerp--FWO (Fund for Scientific Research)- Flanders Belgium (grant code: G.0402.00), University of Antwerp, Flemish Health Ministry.Barcelona--Fondo de Investigaciones Sanitarias (grant code: 99/0034-01, and 99/0034-02), Red Respira (RTIC 03/11 ISC IIF). Ciber of Epidemiology and Public Health has been established and founded by Instituto de Salud Carlos III. Basel--Swiss National Science Foundation, Swiss Federal Office for Education & Science, Swiss National Accident Insurance Fund (SUVA). Bergen--Norwegian Research Council; Norwegian Asthma & Allergy Association (NAAF); Glaxo Wellcome AS, Norway Research Fund. Bordeaux--Institut Pneumologique d'Aquitaine. Erfurt--GSF-National Research Centre for Environment & Health, Deutsche Forschungsgemeinschaft (DFG) (grant code FR 1526/1-1). Galdakao--Basque Health Department. Gothenburg--Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences & Allergy Research, Swedish Asthma & Allergy Foundation, Swedish Cancer & Allergy Foundation. Grenoble--Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, Ministere de l'Emploi et de la Solidarite, Direction Generale de la Sante, CHU de Grenoble, Comite des Maladies Respiratoires de l'Isere. Hamburg--GSF-National Research Centre for Environment & Health, Deutsche Forschungsgemeinschaft (DFG) (grant code MA 711/4-1). Ipswich and Norwich--National Asthma Campaign (UK). Huelva--Fondo de Investigaciones Sanitarias (FIS) (grant code: 97/0035-01, 99/0034-01, and 99/0034-02). Montpellier--Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, CHU de Grenoble, Ministere de l'Emploi et de la Solidarite, Direction Generale de la Sante, Aventis (France), Direction Régionale des Affaires Sanitaires et Sociales Languedoc-Roussillon. Oviedo--Fondo de Investigaciones Santarias (FIS) (grant code: 97/0035-01, 99/0034-01, and 99/0034-02). Paris--Ministere de l'Emploi et de la Solidarite, Direction Generale de la Sante, UCBPharma (France), Aventis (France), Glaxo France, Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, CHU de Grenoble. Pavia--Glaxo, Smith & Kline Italy, Italian Ministry of University and Scientific and Technological Research (MURST), Local University Funding for Research 1998 & 1999 (Pavia, Italy). Portland--American Lung Association of Oregon, Northwest Health Foundation, Collins Foundation, Merck Pharmaceutical. Reykjavik--Icelandic Research Council, Icelandic University Hospital Fund. Tartu--Estonian Science Foundation. Turin--ASL 4 Regione Piemonte (Italy), AO CTO/ICORMA Regione Piemonte (Italy), Ministero dell'Università e della Ricerca Scientifica (Italy), Glaxo Wellcome spa (Verona, Italy). Umeå--Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences & Allergy Research, Swedish Asthma & Allergy Foundation, Swedish Cancer & Allergy Foundation. Uppsala--Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences & Allergy Research, Swedish Asthma & Allergy Foundation, Swedish Cancer & Allergy Foundation. Verona--University of Verona; Italian Ministry of University and Scientific and Technological Research (MURST); Glaxo, Smith & Kline Italy.