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Background Health-Related Quality of Life (HRQoL) is a critical patient-centered outcome in chronic lung diseases, where symptoms are progressive and debilitating with limited treatment options. In Chronic Pulmonary Aspergillosis (CPA), HRQoL can be severely affected by symptom severity, frequent relapses, and side effects of treatments. However, a disease-specific HRQoL tool for CPA has not been developed, making it challenging to identify endpoints for therapeutic trials.Aim To develop and validate the Chronic Pulmonary Aspergillosis Health Assessment Questionnaire (CPA-HAQ), a novel disease-specific HRQoL tool.Method A multi-phase, mixed-method study was designed to develop a reliable HRQoL tool. Phase 1 (domain identification and item generation) involved a thematic analysis of focus groups and expert consultations to generate 43 items. Phase 2 (item reduction) involved 98 patients who assessed the relevance, importance, and clarity of these items over the past month using a 5-point scale. A face validity study (n=98 patients and n=20 experts) led to the refinement and elimination of irrelevant items. Exploratory Factor Analysis (EFA) and Rasch analysis were performed on the 33 items to further refine items on the CPA-HAQ.Results The scale-level face validity index (S-FVI/Ave) was 0.67, showing initial moderate validity of the scale, while the universal agreement index (S-FVI/UA) was relatively high at 0.91. EFA showed clean item loadings (≥ 0.40), indicating distinct dimensions. Rasch analysis revealed good fit statistics (infit/outfit MNSQ = 0.70–1.30), confirming most items were well-fitting. Initial Scale reliability is (α= 0.86), which indicates good internal consistency among the items in the scale. The final version of CPA-HAQ includes 16 items: sputum, haemoptysis, weight loss, dyspnoea, appetite, fever, chest infection, chest pain, chest wheezing, nocturnal awakening, exacerbation, fatigue, physical activity, psychological burden, and general health.Abstract S124 Figure 1Conclusion The CPA-HAQ was developed with input from patients and experts, including the most relevant and frequent symptoms for CPA patients. A Phase 3 clinical validation study is currently ongoing in three UK centers (n=100) to further assess its reliability, validity, and usability to extend its use in clinical practice and research settings.