The Maugeri Respiratory Failure (MRF-28) and Severe Respiratory Insufficiency (SRI) questionnaires were recently developed to assess health-related quality of life (HRQoL) in patients with chronic respiratory failure, although not exclusively in chronic obstructive pulmonary disease (COPD) patients. The aim of the present study was to investigate whether the MRF-28 and SRI are reliable and valid HRQoL questionnaires in COPD patients with chronic hypercapnic respiratory failure (CHRF).In total, 72 COPD patients with CHRF underwent pulmonary function and exercise testing, and completed the MRF-28, the SRI, the Chronic Respiratory Questionnaire (CRQ), the Hospital Anxiety and Depression Scale, the Groningen Activity and Restriction Scale and two dyspnoea indexes.Physical domain scores of the questionnaires correlated with exercise tolerance, dyspnoea and daily activities, while psychological domains correlated strongly with anxiety and depression. Anxiety scores accounted for 51 and 56% of the total explained variance in total CRQ and SRI scores, respectively. The emphasis of the MRF-28 was restrictions in activities of daily living (52% of total variance).In conclusion, the present study showed that the Maugeri Respiratory Failure and Severe Respiratory Insufficiency questionnaires were reliable and valid questionnaires in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure. While the emphasis in the Maugeri Respiratory Failure questionnaire is on activities of daily living, the Severe Respiratory Insufficiency questionnaire, like the Chronic Respiratory Questionnaire, is more related to anxiety and depression. KEYWORDS: Chronic obstructive pulmonary disease, quality of life, respiratory insufficiency C hronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide [1]. As COPD is a progressive disease, the number of COPD patients with severe disease and chronic respiratory failure will increase in the coming years. It has been shown that patients with chronic respiratory failure have poor survival. A 5-yr mortality of 70-100% was reported [2]. Survival rates are difficult to improve once patients have become respiratory insufficient. Despite treatment with long-term oxygen or home mechanical ventilation (HMV), median survival was still only 3 yrs [3].Although survival rates are difficult to improve, therapeutic interventions in severe COPD might nevertheless improve health-related quality of life (HRQoL) [4,5]. The Chronic Respiratory Questionnaire (CRQ) is a widely used diseasespecific questionnaire that has been shown to be reliable, valid and responsive in COPD patients [6]. It has also been used in more severe patients [7][8][9]. However, it was not designed for patients with chronic respiratory failure and might not include items specifically important for these patients. Therefore, a need was felt for questionnaires specific for patients with respiratory failure [10]. The Maugeri Respiratory Failure (MRF-28) and Severe Re...