Tools for Assessing Outcomes in Studies of Chronic Cough: CHEST Guideline and Expert Panel Report

doi:10.1378/chest.14-2506

Chest

Volume 147, Issue 3, March 2015, Pages 804-814

https://doi.org/10.1378/chest.14-2506 Get rights and content

BACKGROUND

Since the publication of the 2006 American College of Chest Physicians (CHEST) cough guidelines, a variety of tools has been developed or further refined for assessing cough. The purpose of the present committee was to evaluate instruments used by investigators performing clinical research on chronic cough. The specific aims were to (1) assess the performance of tools designed to measure cough frequency, severity, and impact in adults, adolescents, and children with chronic cough and (2) make recommendations or suggestions related to these findings.

METHODS

By following the CHEST methodologic guidelines, the CHEST Expert Cough Panel based its recommendations and suggestions on a recently published comparative effectiveness review commissioned by the US Agency for Healthcare Research and Quality, a corresponding summary published in CHEST, and an updated systematic review through November 2013. Recommendations or suggestions based on these data were discussed, graded, and voted on during a meeting of the Expert Cough Panel.

RESULTS

We recommend for adults, adolescents (≥ 14 years of age), and children complaining of chronic cough that validated and reliable health-related quality-of-life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough, such as the Leicester Cough Questionnaire and the Cough-Specific Quality-of-Life Questionnaire in adult and adolescent patients and the Parent Cough-Specific Quality of Life Questionnaire in children. We recommend acoustic cough counting to assess cough frequency but not cough severity. Limited data exist regarding the performance of visual analog scales, numeric rating scales, and tussigenic challenges.

CONCLUSIONS

Validated and reliable cough-specific health-related QoL questionnaires are recommended as the measurement of choice to assess the impact of cough on patients. How they compare is yet to be determined. When used, the reporting of cough severity by visual analog or numeric rating scales should be standardized. Previously validated QoL questionnaires or other cough assessments should not be modified unless the new version has been shown to be reliable and valid. Finally, in research settings, tussigenic challenges play a role in understanding mechanisms of cough.

Section snippets

Summary of Recommendations

1
In adult and adolescent patients (≥ 14 years of age) complaining of chronic cough, we recommend that validated and reliable health-related quality of life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough on patients (Grade 1B).
2
In adults and adolescents with chronic cough, we recommend the Cough-Specific Quality-of-Life Questionnaire and Leicester Cough Questionnaire, as they are the most extensively studied and commonly used previously validated and

Methods

The methodology used by the CHEST Guidelines Oversight Committee to select the Expert Cough Panel chair and the international panel of experts and to perform the synthesis of the evidence to develop the recommendations and suggestions has been previously published.7, 8 In addition to the quality of the evidence, the recommendation grading also includes a strength of recommendation dimension. In the context of practice recommendations, a strong recommendation applies to almost all patients,

Results

The original CER report identified 115 articles representing 121 unique studies that underwent full-text review and 78 studies that met inclusion criteria for the review.5, 9 The updated literature search identified an additional 105 studies for full-text review, 27 of which met inclusion criteria, for a total of 105 eligible studies. The updated search did not change the conclusions of the initial report.

Areas for Future Research

To advance the field, a number of research endeavors should be undertaken, as follows:

•
It should not be assumed that QoL questionnaires would perform equally in all studies, across different cultures, and in different populations. Therefore, to assess the performance of QoL questionnaires, their reliability and validity should be reassessed in all studies going forward, including longitudinal studies. Concurrent validity of QoL questionnaires may be assessed by comparing results of cough

Conclusions

Since publication of the 2006 CHEST cough guidelines, it is clear that the field of cough assessment has advanced based on the results of the systematic review commissioned by AHRQ and performed by methodologists with no conflicts of interest at the Duke Evidence-based Practice Center. By updating the original review through November 2013 and using the updated results as the basis for the present deliberations, the CHEST Expert Cough Panel has made a series of recommendations and suggestions

Acknowledgments

Author contributions: L.-P. B. and R. S. I. were the guarantors and topic editors for this article. L.-P. B., R. R. C., D. C. M., C. T. F, A. B. C., S. S. B., J. S., R. L. D., B. R., and R. S. I. contributed to the development of the key questions using the PICOTS format and review of the data and elaboration of recommendations, including their grading; R. L. D. was the methodologist; and R. R. C. and D. C. M. were among the investigators from the Duke Evidence-based Practice Center who

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Cited by (96)

Development of the Rapid Cough Questionnaire: Key item identification
2024, Annals of Allergy, Asthma and Immunology
The Leicester Cough Questionnaire (LCQ) is a reliable tool for measuring the multidimensional impact of cough on patients’ quality of life; however, its scoring algorithm is lengthy and complex for routine clinical use.
The study aimed to develop a simplified version of the LCQ, the Rapid Cough Questionnaire (RCQ), as a substitue in clinical practice and validate the RCQ using an independent cohort.
To select items for the RCQ score, a correlation network was used to determine the items from each domain that were strongly correlated with the total LCQ score. The final items for the RCQ were selected on the basis of the centrality of the node degree, betweenness, and closeness in the correlation network.
The RCQ score was derived from 3 items: tiredness (LCQ3) in the physical domain, the feeling of being fed up (LCQ13) in the psychological domain, and annoyance with partner/family/friends (LCQ19) in the social domain. The correlation between the LCQ and RCQ was high, with a coefficient of 0.93 (P < .001). The mean score of the RCQ was 11.2 ± 3.2, with scores ranging from 5.15 to 19.55. The minimal clinically important difference in the RCQ score was calculated to be 1.6 using a distribution-based method. The concurrent validity of the LCQ and the RCQ with cough numeric rating scale was similar. In the validation cohort, the correlation between the LCQ and RCQ scores was consistent regardless of sex and etiology.
The RCQ score, which is concise, reliable, and valid, can be a valuable tool for patient assessment, particularly in clinical practice.
Patient Global Impression of Severity Scale in Chronic Cough: Validation and Formulation of Symptom Severity Categories
2023, Journal of Allergy and Clinical Immunology: In Practice
The Patient Global Impression of Severity (PGI-S) scale is a self-reported, single-item categorical scale that is increasingly used when assessing chronic cough (CC).
This study aimed to establish validity, repeatability, and responsiveness of the PGI-S scale in CC and use the scale to define discrete categories of severity when measured with other commonly used patient-reported outcome (PRO) tools.
Consecutive patients with CC completed the PGI-S scale, cough severity and urge to cough visual analog scales (VAS), and cough-specific health status Leicester Cough Questionnaire (LCQ) at a clinic visit. Validity, repeatability, and responsiveness were assessed, and threshold scores for PRO severity categories determined.
A total of 482 participants completed the assessments; the median (interquartile range [IQR]) age was 57 (46-67) years, 71% were female, and the median (IQR) duration of cough was 48 (24-120) months. They reported a median (IQR) PGI-S score of 3 (3-4; moderate severity), cough severity VAS of 57 (31-75) mm, urge to cough VAS of 62 (40-81) mm, and LCQ of 11.5 (8.7-14.4). There were strong associations between PGI-S scores and cough severity VAS (ρ = 0.81), urge to cough VAS (ρ = 0.73), and LCQ (ρ = −0.73) (all P < .001). Repeatability of the PGI-S scale was high (n = 77); the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.77-0.91) (P < .001). The PGI-S scale was responsive in participants with a treatment response (P < .001). The suggested PRO thresholds to define severe cough are ≥61 mm (cough severity VAS), ≥71 mm (urge to cough VAS), and ≤10 (LCQ).
The PGI-S scale is a simple and valid tool that characterizes cough severity and is repeatable and responsive in CC. The proposed categorical severity thresholds for VAS and LCQ can provide intuitive meaning for patients and clinicians.
Management of non-pharmacologic therapy for chronic refractory cough: Mechanism, composition, applicable population, and assessment
2023, Heliyon
Chronic cough is common in the clinic and can seriously affect the quality of life of patients. Following the existing guidelines for treatment, refractory chronic cough is defined as a clinical condition in which the cause of the cough remains unclear after comprehensive examination and treatment, or the cause is clear but symptomatic treatment is ineffective.
It has been found that non-pharmacologic therapy can effectively improve the quality of life and reduce the frequency of coughing for some patients with refractory chronic cough. Compared with pharmacological therapy, non-pharmacologic therapy has no obvious adverse effects; therefore, non-pharmacologic therapy has good application prospects in the diagnosis and treatment of refractory chronic cough. This paper summarizes the composition, indication, action and mechanism of non-pharmacologic therapy in the diagnosis and treatment of refractory chronic cough and prospects for research on non-pharmacologic therapy.
Validation of the Japanese version of the Manchester Cough in Lung Cancer Scale
2021, Respiratory Investigation
Citation Excerpt :
Health-related QOL measures to assess the impact of cough in adults and adolescents include the validated Leicester Cough Questionnaire (LCQ) [4] and Cough-Specific Quality of Life Questionnaire [5]. The cough guidelines recommend that validated and reliable health-related QOL questionnaires be used as the measurement of choice to assess the impact of cough on patients [6]. The LCQ has been evaluated in patients with asthma, COPD, GERD, and chronic idiopathic cough [7,8].
Cough is one of the most common distressing symptoms of lung cancer. However, there is no specific measure of cough in lung cancer in Japanese. The present study aimed to determine the validity of the Japanese version of the Manchester Cough in Lung Cancer Scale (MCLCS).
The MCLCS is a cough-specific quality of life (QOL) questionnaire for lung cancer that consists of 10 items on cough frequency, distress, impact, and severity. Items are evaluated on a scale of 1–5 (1: never, 2: some of the time, 3: often, 4: most of the time, and 5: all of the time). Total scores can range from 1 to 50, with higher scores indicating worse cough-related QOL. The Japanese version of the MCLCS was created through forward and backward translation. Patients completed the Japanese version of the MCLCS, the Leicester Cough Questionnaire (LCQ), and the cough visual analog scale (VAS). To confirm the reliability of the MCLCS, Cronbach's α coefficient was calculated, and for validity, the Spearman's rank correlation coefficient was used to assess the correlations between MCLCS and LCQ or cough VAS.
Of the total 192 lung cancer patients enrolled in this study, 73 had a cough in the preceding week. The median MCLCS score was 28, demonstrating an excellent internal consistency (Cronbach's α coefficient = 0.83). MCLCS was strongly and significantly correlated with LCQ and cough VAS.
The Japanese version of MCLCS is a valid tool for assessing cough in lung cancer patients.
Research status of east Asian traditional medicine treatment for chronic cough: A scoping review
2024, PLoS ONE
Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept
2023, Clinics and Practice

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FUNDING/SUPPORT: Funding was provided by ACCP (CHEST).

DISCLAIMER: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1473S1.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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Chest

Evidence-Based MedicineTools for Assessing Outcomes in Studies of Chronic Cough: CHEST Guideline and Expert Panel Report

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Section snippets

Summary of Recommendations

Methods

Results

Areas for Future Research

Conclusions

Acknowledgments

Chest

Chest

Chest

Chest

Chest

Chest

Respir Med

J Pain Symptom Manage

Chest

Chest

Chest

J Allergy Clin Immunol

Cough

Lancet

Chest

J Clin Epidemiol

Respir Med

Chest

Ann Allergy Asthma Immunol

Chest

Chest

Chest

Chest

Respir Med

Chest

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Chest

Chest

British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults

Thorax

Feasibility study: honey for treatment of cough in children

Pediatr Rep

Patient-reported outcomes to assess the efficacy of extended-release guaifenesin for the treatment of acute respiratory tract infection symptoms

Respir Res

Data reduction for cough studies using distribution of audio frequency content

Cough

To compare the effect of dextromethorphan, promethazine and placebo on nocturnal cough in children aged 1-12 y with upper respiratory infections: a randomized controlled trial

Indian J Pediatr

Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study

Pediatrics

Fundoplication in chronic intractable cough

Cough

The development of a patient-reported outcome measure for assessing nighttime symptoms of chronic obstructive pulmonary disease

Health Qual Life Outcomes

Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease

J Clin Nurs

Symptom reports are not reliable during ambulatory reflux monitoring

Am J Gastroenterol

Capability of hypertonic saline cough provocation test to predict the response to inhaled corticosteroids in chronic cough: a prospective, open-label study

Cough

Validation of an automated cough detection algorithm for tracking recovery of pulmonary tuberculosis patients

PLoS One

A longitudinal assessment of acute cough

Am J Respir Crit Care Med

Predictors of objective cough frequency in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Inhaled corticosteroids for subacute cough in children

Cochrane Database Syst Rev

A cough algorithm for chronic cough in children: a multicenter, randomized controlled study

Pediatrics

Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway

Laryngoscope

Evidence-Based Medicine
Tools for Assessing Outcomes in Studies of Chronic Cough: CHEST Guideline and Expert Panel Report