Cough symptom severity in patients with refractory or unexplained chronic cough: a systematic survey and conceptual framework

Abstract

BackgroundCough severity represents an important subjective endpoint in assessing the effectiveness of therapies for patients with chronic cough. Although cough-specific quality of life questionnaires exist, a widely available cough severity instrument with established measurement properties remains unavailable.AimsTo identify and summarise the results of studies reporting on the experience of patients with chronic cough and, in the process, develop a conceptual framework to inform development of a patient-reported outcome measurement (PROM) addressing cough severity.ResultsWe identified 61 eligible studies reporting on patient experience with chronic cough. Studies provided 82 potential items, of which 43 proved unique and relevant to cough severity. The urge-to-cough sensation and the cough symptom itself represented broad domains of cough severity. Two subdomains under urge-to-cough included frequency (1 item) and intensity (1 item). Five subdomains under cough symptoms included control (2 items), frequency (6 items), bout duration (1 item), intensity (8 items), and associated features/sequelae (24 items).ConclusionsOur systematic survey and conceptual framework identified items and domains of cough severity in patients with refractory or unexplained chronic cough. The results support item generation and content validity for a PROM assessing cough severity.

Normative Values for the Leicester Cough Questionnaire in Healthy Individuals

“…A conceptual framework of cough severity based on different domains that address symptoms ranging from urge-to-cough to cough frequency, intensity, duration and associated features has been proposed. 12 Until such questionnaires are validated, patient-reported outcome measures, like the LCQ, will likely continue to be used predominantly in clinical practice. The data presented here will assist practitioners in assessing degree of severity of quality-of-life impacts of cough at treatment onset and when assessing treatment response.…”

Assessing cough symptom severity in refractory or unexplained chronic cough: findings from patient focus groups and an international expert panel

“…led the focus group discussions over Zoom videoconferencing, each for 60–90 min. A prior systematic survey [ 16 ] informed an initial draft of the interview guide that was subsequently revised based on input from the steering group (G.H.G., I.S.). The facilitator asked open-ended questions, followed by directed questions on themes identified from the systematic survey.…”

“…We used directed content analysis, informed by a prior conceptual framework [ 16 ], to identify related themes [ 20 ]. Two researchers (E.K., C.M.)…”

“…We aim to develop a cough symptom severity instrument—the McMaster Cough Severity Questionnaire—for use in patients with RCC/UCC. To inform item generation for the instrument, we conducted a systematic survey in which we identified 43 items addressing the following domains: urge-to-cough sensations (subdomains: frequency and intensity) and cough symptom (subdomains: frequency, control, bout duration, intensity and associated features/sequelae) [ 16 ]. To assess the comprehensiveness and appropriateness of items, domains and subdomains identified in our systematic survey, we conducted patient focus groups and consultation with clinical experts, and report here our findings.…”

Chronic cough—the limitation and advances in assessment techniques

“…The McMaster cough severity questionnaire is a newly developed cough symptom severity instrument for RCC patients and provided 43 items addressing the following domains: urge-to-cough sensations (subdomains: frequency and intensity) and cough symptom (subdomains: frequency, control, bout duration, intensity, and associated features/sequelae) ( 186 , 195 ). This currently is a conceptual framework.…”