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Koo HK, Moon JY, Kim JW, Jang SH, Kwon JW, Lee BJ, Park YB, Kim DK. Development of the Rapid Cough Questionnaire: Key item identification. Ann Allergy Asthma Immunol 2024; 132:491-496.e4. [PMID: 38158042 DOI: 10.1016/j.anai.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND 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. OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION The RCQ score, which is concise, reliable, and valid, can be a valuable tool for patient assessment, particularly in clinical practice.
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Affiliation(s)
- Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea.
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Narteni S, Baiardini I, Braido F, Mongelli M. Explainable artificial intelligence for cough-related quality of life impairment prediction in asthmatic patients. PLoS One 2024; 19:e0292980. [PMID: 38502606 PMCID: PMC10950232 DOI: 10.1371/journal.pone.0292980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
Explainable Artificial Intelligence (XAI) is becoming a disruptive trend in healthcare, allowing for transparency and interpretability of autonomous decision-making. In this study, we present an innovative application of a rule-based classification model to identify the main causes of chronic cough-related quality of life (QoL) impairment in a cohort of asthmatic patients. The proposed approach first involves the design of a suitable symptoms questionnaire and the subsequent analyses via XAI. Specifically, feature ranking, derived from statistically validated decision rules, helped in automatically identifying the main factors influencing an impaired QoL: pharynx/larynx and upper airways when asthma is under control, and asthma itself and digestive trait when asthma is not controlled. Moreover, the obtained if-then rules identified specific thresholds on the symptoms associated to the impaired QoL. These results, by finding priorities among symptoms, may prove helpful in supporting physicians in the choice of the most adequate diagnostic/therapeutic plan.
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Affiliation(s)
- Sara Narteni
- CNR-IEIIT, Genoa, Italy
- DAUIN Department, Politecnico di Torino, Turin, Italy
| | - Ilaria Baiardini
- Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy
| | - Fulvio Braido
- Respiratory Diseases and Allergy Department, IRCCS Polyclinic Hospital San Martino, Genoa, Italy
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Lee B, Kwon CY, Kim YJ, Kim JH, Kim KI, Lee BJ, Lee JH. Research status of east Asian traditional medicine treatment for chronic cough: A scoping review. PLoS One 2024; 19:e0296898. [PMID: 38330020 PMCID: PMC10852285 DOI: 10.1371/journal.pone.0296898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND When patients continue to experience cough despite conventional treatment, East Asian traditional medicine (EATM) including herbal medicine and/or acupuncture has been frequently used. Previous systematic reviews of EATM treatment for chronic cough have been conducted mainly on herbal medicine, targeting patients with conditions that cause cough. In clinical practice, EATM interventions are not limited to herbal medicine, and considering that chronic cough is often caused by two or more conditions or unspecific causes, a comprehensive investigation is clinically relevant. We examined the current research status of EATM for chronic cough. METHODS Based on Arksey and O'Malley's scoping review methodological framework, a total of six English, Chinese, Korean, and Japanese electronic databases were searched on August 2022. Any clinical studies on EATM targeting chronic cough patients (regardless of their cause) were included. RESULTS Among 474 included studies, the study designs were mainly randomized controlled trials (72.4%), and the population was evenly distributed between children and adults. The cause of cough was not reported in most studies (56.1%). The common cause of cough was upper airway cough syndrome and post-respiratory infection (9.5%, each), followed by mixed cause (7.6%), nonspecific cause (5.9%), and gastroesophageal reflux disease (4.0%). EATM was conducted for a mean of 19.1 days, and herbal medicine was the most common (80.6%). Conventional medication was frequently used as a control (81.2%). For outcomes, the total effective rate was the most frequently utilized (94.3%), followed by cough severity (53.8%). EATM treatment showed positive outcomes in most studies. CONCLUSIONS In future EATM studies, it is necessary to either specify the cause of chronic cough or to report that the study was targeting nonspecific chronic cough. In addition, high-quality studies assessing the efficacy of EATM with placebo control treatment should be conducted, using validated evaluation tools.
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Affiliation(s)
- Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, South Korea
| | - Ye Ji Kim
- Department of Korean Pediatrics, Kyung Hee University Medical Center, Seoul, South Korea
| | - Jae Hyun Kim
- Department of Korean Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Kwan-Il Kim
- Department of Internal Medicine, Division of Allergy, Immune and Respiratory System, College of Korean Medicine, Kyung Hee Medical Center, Kyung Hee University, Seoul, South Korea
| | - Beom-Joon Lee
- Department of Internal Medicine, Division of Allergy, Immune and Respiratory System, College of Korean Medicine, Kyung Hee Medical Center, Kyung Hee University, Seoul, South Korea
| | - Jun-Hwan Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- Department of Korean Convergence Medical Science, KIOM School, University of Science & Technology (UST), Daejeon, South Korea
- Department of Radiology, Athinoula A. Martinos Center for Biomedical imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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Zhou X, Lei C, Wei X, Dai W, Xu W, Ao Y, Li X, Qiao G, Shi Q. Patient's experiences of coughing after lung cancer surgery: A multicenter qualitative study. Cancer Med 2024; 13:e6993. [PMID: 38348918 PMCID: PMC10839156 DOI: 10.1002/cam4.6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE Cough is one of the most common symptoms after lung cancer surgery, which seriously affects the quality of life. Little research has been conducted on patient's experiences of cough following lung surgery. This study aimed to elucidate the experience of coughing after lung cancer surgery from the patient's perspective regarding symptoms and their impacts on daily life, as well as triggers and dealing strategies. METHODS Between June 2023 and July 2023, we conducted semi-structured interviews with patients from outpatient clinics of two hospitals who were pathologically diagnosed with lung cancer and experienced cough after surgery through convenience sampling. The interview recordings were transcribed and analyzed by two researchers. The traditional content analysis and thematic analysis were used to identify the common codes, subthemes, and themes. RESULTS A total of 28 participants were interviewed. The mean age of the participants was 55.21 years (range: 36-75 years), and 21 participants were female. Most patients (75%) were interviewed within 6 months of surgery. We identified five themes (accompanying symptoms, incentives, effects, solution, and information sources) and 12 subthemes (local symptoms, systemic symptoms, personal factors, external factors, emotion, relationship with others, reduced quality of life, medical measures, nonmedical measures, no measures, relatives and friends, and the Internet). Patients with lung cancer may experience various cough symptoms after surgery, which a variety of internal and external factors can trigger. The coughing imposes a double burden on the physical and psychological due to the negative emotions it provokes. CONCLUSION We generated a concept framework of cough after lung cancer surgery, providing a basis for further development of measurement tools from the patients' perspective. The lack of knowledge related to coughing highlights the need for adequate and timely health education and professional medical care.
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Affiliation(s)
- Xiangxi Zhou
- School of Public HealthChongqing Medical UniversityChongqingChina
| | - Cheng Lei
- School of Public HealthChongqing Medical UniversityChongqingChina
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduSichuanChina
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduSichuanChina
| | - Wei Xu
- School of Public HealthChongqing Medical UniversityChongqingChina
| | - Yongping Ao
- School of Public HealthChongqing Medical UniversityChongqingChina
| | - Xianglin Li
- Department of Thoracic SurgeryGuangdong Provincial People's HospitalGuangdongChina
| | - Guibin Qiao
- Department of Thoracic SurgeryGuangdong Provincial People's HospitalGuangdongChina
| | - Qiuling Shi
- School of Public HealthChongqing Medical UniversityChongqingChina
- Department of Thoracic Surgery, Sichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduSichuanChina
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Zhou X, Lei C, Wei X, Dai W, Xu W, Ao Y, Li X, Qiao G, Shi Q. Patient's experiences of coughing after lung cancer surgery: A multicenter qualitative study. Cancer Med 2024; 13. [DOI: https:/doi.org/10.1002/cam4.6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
AbstractPurposeCough is one of the most common symptoms after lung cancer surgery, which seriously affects the quality of life. Little research has been conducted on patient's experiences of cough following lung surgery. This study aimed to elucidate the experience of coughing after lung cancer surgery from the patient's perspective regarding symptoms and their impacts on daily life, as well as triggers and dealing strategies.MethodsBetween June 2023 and July 2023, we conducted semi‐structured interviews with patients from outpatient clinics of two hospitals who were pathologically diagnosed with lung cancer and experienced cough after surgery through convenience sampling. The interview recordings were transcribed and analyzed by two researchers. The traditional content analysis and thematic analysis were used to identify the common codes, subthemes, and themes.ResultsA total of 28 participants were interviewed. The mean age of the participants was 55.21 years (range: 36–75 years), and 21 participants were female. Most patients (75%) were interviewed within 6 months of surgery. We identified five themes (accompanying symptoms, incentives, effects, solution, and information sources) and 12 subthemes (local symptoms, systemic symptoms, personal factors, external factors, emotion, relationship with others, reduced quality of life, medical measures, nonmedical measures, no measures, relatives and friends, and the Internet). Patients with lung cancer may experience various cough symptoms after surgery, which a variety of internal and external factors can trigger. The coughing imposes a double burden on the physical and psychological due to the negative emotions it provokes.ConclusionWe generated a concept framework of cough after lung cancer surgery, providing a basis for further development of measurement tools from the patients' perspective. The lack of knowledge related to coughing highlights the need for adequate and timely health education and professional medical care.
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Affiliation(s)
- Xiangxi Zhou
- School of Public Health Chongqing Medical University Chongqing China
| | - Cheng Lei
- School of Public Health Chongqing Medical University Chongqing China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Wei Xu
- School of Public Health Chongqing Medical University Chongqing China
| | - Yongping Ao
- School of Public Health Chongqing Medical University Chongqing China
| | - Xianglin Li
- Department of Thoracic Surgery Guangdong Provincial People's Hospital Guangdong China
| | - Guibin Qiao
- Department of Thoracic Surgery Guangdong Provincial People's Hospital Guangdong China
| | - Qiuling Shi
- School of Public Health Chongqing Medical University Chongqing China
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China Chengdu Sichuan China
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Kang J, Seo WJ, Kim JG, Moon JY, Kim DK, Kim JW, Jang SH, Kwon JW, Lee BJ, Koo HK. Sex-related disparities in cough-associated symptoms across different age groups. Ther Adv Respir Dis 2024; 18:17534666241252545. [PMID: 38780129 PMCID: PMC11119368 DOI: 10.1177/17534666241252545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Sex-related disparities in the prevalence of chronic cough have been consistently reported globally, with varying male-to-female ratios. OBJECTIVES This study aimed to evaluate sex-related differences by comparing correlations between cough-related symptoms in males and females of different age groups. DESIGN Adult patients with chronic cough who completed the Leicester Cough Questionnaire (LCQ) were recruited from 16 respiratory centers. METHODS Correlation networks were constructed based on Spearman's correlation coefficients in males and females of various age groups. The distinct relationships of cough-related symptoms between subgroups were validated by an independent cohort. RESULTS A total of 255 patients were enrolled in this study (male-to-female ratio, 1:1.71). The following LCQ items were highly correlated: embarrassment and interference with daily work, anxiety, and interference with overall life enjoyment/feeling of being fed up, interference with daily work and overall life enjoyment, interference with overall life enjoyment and feeling of being fed up, and feeling of being fed up and annoyance to partner/family/friends. The patterns of these correlations between LCQ items varied in males and females of different ages. The strongest interrelationship was observed in male patients aged >50 years old, which was similar to those in the validation cohort. CONCLUSION The correlation patterns between cough-related symptoms vary significantly according to age and sex. Understanding the mechanisms underlying the development of cough-related symptoms may facilitate sex- and age-specific strategies for chronic cough.
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Affiliation(s)
- Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Woo Jung Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jung Gon Kim
- Division of Rheumatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang 10380, Republic of Korea
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Fraser A, Poole P. Immunostimulants versus placebo for preventing exacerbations in adults with chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 11:CD013343. [PMID: 36373977 PMCID: PMC9661939 DOI: 10.1002/14651858.cd013343.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with chronic obstructive pulmonary disease (COPD) or chronic bronchitis may experience recurrent exacerbations, which negatively impact prognosis and quality of life, and can impose a significant socioeconomic burden on the individual and wider society. Immunostimulants are a broad category of therapies that may theoretically enhance non-specific immunity against several respiratory insults, thereby reducing exacerbation risk and severity. However, evidence to date for their use in this population is limited. OBJECTIVES To determine the efficacy of immunostimulants in preventing respiratory exacerbations in adults with chronic obstructive pulmonary disease, chronic bronchitis, or both. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest literature search was conducted on 25 January 2022. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs) that compared immunostimulant therapy, administered by any method and with the intention of preventing (rather than treating) exacerbations, with placebo for a minimum treatment duration of one month in adults with chronic bronchitis or COPD, or both. We excluded participants with other respiratory conditions. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were number of participants with no exacerbations during the study period and all-cause mortality, secondary outcomes were respiratory-related mortality, quality of life, number of participants requiring antibiotics, exacerbation duration, respiratory-related hospitalisation duration and adverse events/side effects. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS This review included 36 studies involving 6192 participants. Studies were published between 1981 and 2015. Duration ranged from three to 14 months. The mean age of study participants varied between 35.2 and 82 years. Twelve studies examined participants with COPD only. Seventeen studies reported baseline lung function values; most indicated a moderate-to-severe degree of airflow limitation. Nineteen studies indicated inclusion of participants with a mean baseline exacerbation frequency of two or more in the preceding year. Immunostimulants investigated were OM-85, AM3, RU41740 (Biostim), Ismigen, Diribiotine CK, thymomodulin, pidotimod, D53 (Ribomunyl), Lantigen B, Symbioflor, and hyaluronan; routes of administration were oral, sublingual, and subcutaneous. The risk of bias of the included studies was mostly low or unclear. Participants receiving immunostimulants for a mean duration of six months were slightly more likely to be free of exacerbations during that time (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.15 to 1.90; 15 RCTs, 2961 participants; moderate-certainty evidence). The overall number needed to treat with immunostimulants for a mean of six months, to prevent one participant from experiencing an exacerbation, was 11 (95% CI 7 to 29). This outcome was associated with a moderate degree of unexplained heterogeneity (I2 = 53%). Type of immunostimulant, baseline lung function, baseline exacerbation frequency, treatment duration, and follow-up duration did not modify the effect size, although due to heterogeneity and limited study and participant numbers within some subgroups, the validity of the subgroup treatment effect estimates were uncertain. Immunostimulants probably result in little to no difference in all-cause mortality (OR 0.64, 95% CI 0.37 to 1.10; 5 RCTs, 1558 participants; moderate-certainty evidence) and respiratory-related mortality (OR 0.40, 95% CI 0.15 to 1.07; 2 RCTs, 735 participants; low-certainty evidence) compared to placebo; however, the effects were imprecise and data quality limited the certainty of these results. There was a small improvement in health-related quality of life, as measured by the St George's Respiratory Questionnaire (SGRQ), with immunostimulant compared to placebo (mean difference -4.59, 95% CI -7.59 to -1.59; 2 RCTs, 617 participants; very-low certainty evidence). The effect estimate just met the minimum clinically important difference (MCID) score of 4 units; however, the CI width means the possibility of a non-meaningful difference cannot be excluded. The pooled result from five studies indicated that immunostimulants likely reduce the number of participants requiring antibiotics over a mean duration of six months (OR 0.34, 95% CI 0.18 to 0.63; 542 participants; moderate-certainty evidence). This outcome had a low-to-moderate degree of heterogeneity (I2 = 38%), but the direction of effect was consistent across all studies. There was no evidence of a difference in the odds of experiencing an adverse event with immunostimulant compared to placebo, over a mean duration of six months (OR 1.01, 95% CI 0.84 to 1.21; 20 RCTs, 3780 participants; high-certainty evidence). The CI limits for the associated risk ratio (RR) did not cross thresholds for appreciable harm or benefit (RR 1.02, 95% CI 0.92 to 1.13). An additional seven studies reported no events rates in either study arm. Meta-analyses were not performed for the outcomes of exacerbation duration and respiratory-related hospitalisation duration, due to high levels of heterogeneity across the included studies (exacerbation duration: I2 = 92%; respiratory-related hospitalisation duration: I2 = 83%). Results from an effect direction plot and binomial probability test for exacerbation duration indicated that a significant proportion of studies (94% (95% CI 73% to 99%); P = 0.0002) favoured intervention, possibly indicating that immunostimulants are efficacious in reducing the mean exacerbation duration compared to placebo. However, the degree of uncertainty associated with this estimate remained high due to data quality and heterogeneity. Three studies reported mean duration of respiratory-related hospitalisation, two of which demonstrated a direction of effect that favoured immunostimulant over placebo. AUTHORS' CONCLUSIONS In participants with chronic bronchitis or COPD, we are moderately confident that treatment with immunostimulants is associated with a small reduction in the likelihood of having an exacerbation and a moderate reduction in the requirement for antibiotics. Low numbers of events limit interpretation of the effect of immunostimulants on all-cause and respiratory-related mortality. We are uncertain whether immunostimulants improve quality of life, and whether they are associated with a reduction in exacerbation and respiratory-related hospitalisation durations, although immunostimulants were generally associated with a positive effect direction in the studies that examined these outcomes. Immunostimulants appear to be safe and well-tolerated, and are not associated with an increased risk of adverse events.
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Affiliation(s)
| | - Phillippa Poole
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Rouadi PW, Idriss SA, Bousquet J, Laidlaw TM, Azar CR, Al-Ahmad MS, Yañez A, Al-Nesf MAY, Nsouli TM, Bahna SL, Abou-Jaoude E, Zaitoun FH, Hadi UM, Hellings PW, Scadding GK, Smith PK, Morais-Almeida M, Maximiliano Gómez R, Gonzalez Diaz SN, Klimek L, Juvelekian GS, Riachy MA, Canonica GW, Peden D, Wong GW, Sublett J, Bernstein JA, Wang L, Tanno LK, Chikhladze M, Levin M, Chang YS, Martin BL, Caraballo L, Custovic A, Ortego-Martell JA, Lesslar OJ, Jensen-Jarolim E, Ebisawa M, Fiocchi A, Ansotegui IJ. WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19. World Allergy Organ J 2022; 15:100649. [PMID: 35600836 PMCID: PMC9117692 DOI: 10.1016/j.waojou.2022.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
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Affiliation(s)
- Philip W. Rouadi
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait
| | - Samar A. Idriss
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France
| | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- Macvia France, Montpellier France
- Université Montpellier, Montpellier, France
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA
| | - Cecilio R. Azar
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
| | - Mona S. Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Anahi Yañez
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Maryam Ali Y. Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | | | - Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | | | - Fares H. Zaitoun
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
| | - Usamah M. Hadi
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
| | - Peter W. Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | | | - Peter K. Smith
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
| | | | | | - Sandra N. Gonzalez Diaz
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Georges S. Juvelekian
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Moussa A. Riachy
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon
| | - Giorgio Walter Canonica
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
| | - David Peden
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA
| | - Gary W.K. Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - James Sublett
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
| | - Luciana K. Tanno
- Université Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
| | - Michael Levin
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Bryan L. Martin
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
| | - Adnan Custovic
- National Heart and Lund Institute, Imperial College London, UK
| | | | | | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
- The interuniversity Messerli Research Institute, Medical University Vienna and University of Veterinary Medicine, Vienna, Austria
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Alessandro Fiocchi
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
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9
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Kum E, Guyatt GH, Munoz C, Beaudin S, Li SA, Abdulqawi R, Badri H, Boulet LP, Chen R, Dicpinigaitis P, Dupont L, Field SK, French CL, Gibson PG, Irwin RS, Marsden P, McGarvey L, Smith JA, Song WJ, O'Byrne PM, Satia I. Assessing cough symptom severity in refractory or unexplained chronic cough: findings from patient focus groups and an international expert panel. ERJ Open Res 2022; 8:00667-2021. [PMID: 35295233 PMCID: PMC8918938 DOI: 10.1183/23120541.00667-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cough symptom severity represents an important subjective end-point to assess the impact of therapies for patients with refractory or unexplained chronic cough (RCC/UCC). As existing instruments assessing the severity of cough are neither widely available nor tested for measurement properties, we aim to develop a new patient-reported outcome measure addressing cough severity. Objective The aim of this study was to establish items and domains that would inform development of a new cough severity instrument. Methods Three focus groups involving 16 adult patients with RCC/UCC provided data that we analysed using directed content analysis. Discussions led to consensus among an international panel of 15 experts on candidate items and domains to assess cough severity. Results The patient focus group provided 48 unique items arranged under broad domains of urge-to-cough sensations and cough symptom. Feedback from expert panel members confirmed the appropriateness of items and domains, and provided an additional subdomain related to cough triggers. The final conceptual framework comprised 51 items in the following domains: urge-to-cough sensations (subdomains: frequency and intensity) and cough symptom (subdomains: triggers, control, frequency, fit/bout duration, intensity, quality and associated features/sequelae). Conclusions Consensus findings from patients and international experts established domains of urge-to-cough and cough symptom with associated subdomains and relevant items. The results support item generation and content validity for a novel patient-reported outcome measure for use in health research and clinical practice. The urge-to-cough (subdomains: frequency and intensity) and cough symptom (subdomains: triggers, control, frequency, fit/bout duration, intensity, quality, and associated features/sequelae) represent domains to assess cough severity in RCC/UCChttps://bit.ly/3fI6qkC
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10
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Kum E, Guyatt GH, Devji T, Wang Y, Bakaa L, Lan L, Liu E, Mastrolonardo A, Couban R, O'Byrne PM, Satia I. Cough symptom severity in patients with refractory or unexplained chronic cough: a systematic survey and conceptual framework. Eur Respir Rev 2021; 30:30/161/210104. [PMID: 34261745 DOI: 10.1183/16000617.0104-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cough 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. AIMS To 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. RESULTS We 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). CONCLUSIONS Our 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.
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Affiliation(s)
- Elena Kum
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tahira Devji
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuting Wang
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Layla Bakaa
- Dept of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Lucy Lan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eva Liu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Rachel Couban
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Paul M O'Byrne
- Dept of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Imran Satia
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada .,Dept of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
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11
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Liu W, Wu Q, Mao B, Jiang H. Gender difference in the association between cough severity and quality of life among patients with postinfectious cough. Health Qual Life Outcomes 2021; 19:34. [PMID: 33499889 PMCID: PMC7836494 DOI: 10.1186/s12955-021-01680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Despite close link exists between cough severity and quality of life (QoL), whether gender difference is implied in the effect of cough on QoL has not been studied yet. This study primarily aims to investigate whether the association between cough severity and QoL is modified by gender in patients with postinfectious cough. Methods Secondary analyses were performed in 180 participants with postinfectious cough in a multisite randomized controlled trial. Baseline demographics, clinical characteristics and score of cough specific quality of life questionnaire (CQLQ) were collected. Linear regression analyses were conducted to examine gender difference in CQLQ score and the association between cough severity and CQLQ score. Results Difference between women and men was not significant in CQLQ total score in the unadjusted analysis (P = 0.077). Women had a 2.20-point higher CQLQ total score than men (95% confidence interval (CI) 0.11–4.30; P = 0.039), after adjusting for age, cough duration, cough severity, and clinical center. Gender significantly modified the association between cough severity and CQLQ total score (coefficient 1.80, 95% CI 0.29–3.30; P = 0.020), after adjusting for age, cough duration, and study center. An increase of 1-point in cough severity was associated with a 2.55-point (95% CI 1.16–3.95) increase in CQLQ total score in women versus a 1.26-point (95% CI 0.20–2.31) increase in men (P = 0.020). Conclusions Female sex may be associated with worse QoL than men, and women’s QoL may be more significantly impaired as cough symptom deteriorates. Gender difference should be taken into account in the clinical settings and research of cough and cough related QoL. Trial registration: Chinese Clinical Trial Registry, ChiCTRTRC12002297. Registered 19 June 2012, http://www.chictr.org.cn/abouten.aspx.
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Affiliation(s)
- Wei Liu
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, China.,Department of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital, Sichuan University, 1 Keyuansi Road, Chengdu, 610041, China
| | - Qinqin Wu
- Health Management Center, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, China
| | - Bing Mao
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, China
| | - Hongli Jiang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, China.
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12
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Irwin RS, Dudiki N, French CL. Life-Threatening and Non-Life-Threatening Complications Associated With Coughing: A Scoping Review. Chest 2020; 158:2058-2073. [PMID: 32565267 DOI: 10.1016/j.chest.2020.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This is an update of the section on complications that are associated with coughing in the 2006 CHEST cough guidelines that addresses two aims: (1) to systematically identify and thematically categorize the diverse complications of cough by providing a guide for future studies and (2) to identify gaps in the literature for future research. RESEARCH QUESTION What are the potential complications that are associated with the act of coughing that have been reported in infants, children, adolescents, and adults? STUDY DESIGN AND METHODS A scoping review was performed with the use of PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019. RESULTS Two hundred forty-seven publications met our inclusion criteria. To these, we added 38 articles from the 2006 complications paper that were not identified in the literature search plus the paper itself for a final total of 286 publications that formed the basis of this review. Since 2006, three new categories of complications have been reported: ear, nose and throat; disease transmission; and laboratory testing. Multiple additional complications that fall outside of these three categories have also been identified and included in the following categories: cardiovascular, constitutional symptoms, dermatologic, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial/quality of life, and respiratory. Not previously highlighted is that some of the complications led to serious morbidity that included death, especially in patients with comorbid conditions, and potentially resulted in harm to others when cough resulted in a motor vehicle accident. INTERPRETATION Our work identified a large number of cough complications that we thematically categorized primarily by organ system so that future studies of each system or each complication can be conducted. The gap in the literature that future studies should address is to identify the frequency of the complications and the strength of their association with cough. Only then will one be able to describe the findings in a manner that allows specific recommendations for avoiding these complications. In the meantime, patients with cough should be evaluated and treated according to evidence-based guidelines to mitigate or prevent the myriad of potential complications that are associated with coughing.
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Affiliation(s)
- Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA.
| | - Natasha Dudiki
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Cynthia L French
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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13
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Martin Nguyen A, Bacci E, Dicpinigaitis P, Vernon M. Quantitative measurement properties and score interpretation of the Cough Severity Diary in patients with chronic cough. Ther Adv Respir Dis 2020; 14:1753466620915155. [PMID: 32345170 PMCID: PMC7225816 DOI: 10.1177/1753466620915155] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/18/2020] [Indexed: 12/05/2022] Open
Abstract
AIMS The Cough Severity Diary (CSD) was developed in accordance with the FDA guidance for patient-reported outcome measures and is focused on capturing the patient's perception of cough in terms of frequency, intensity, and disruption due to their cough. The measure includes a series of seven items asking patients to rate the frequency (three items), intensity (two items), and disruptiveness (two items) of their cough. The instrument was designed to be completed daily before bedtime, has a recall period of 'today,' and responses to items are entered on an 11-point numeric rating scale ranging from 0 to 10 with anchors on each end. The objective of this analysis was to confirm the domain structure of the CSD and assess its reliability, validity, and responsiveness in adult patients with refractory or unexplained chronic cough (RCC/UCC). Criteria for defining meaningful changes in mean weekly CSD total and domain scores in the context of a clinical trial were also developed. METHODS Pooled data from a phase II randomized controlled trial of an investigational treatment for RCC/UCC were analyzed. Participants were non-smokers, had RCC/UCC for ⩾1 year, and a baseline cough severity visual analogue scale (VAS) ⩾40 mm. CSD scores (baseline, week 4), were analyzed; the Leicester Cough Questionnaire (LCQ), cough severity VAS, Patient Global Impression of Change (PGIC), and objective cough frequency counts were used for validation. CSD domain structure (Total, Frequency, Intensity, Disruption) was assessed for scoring. RESULTS A total of 253 participants were included (mean age 60.2; 76% female). Global fit of the three-factor CSD was acceptable. For the CSD total score, internal consistency (α = 0.89) and test-retest reliability (intraclass correlation coefficient = 0.68) were high. CSD total scores were correlated with the LCQ total (r = -0.62) and cough severity VAS (r = 0.84). Participants with a PGIC score of 1 or 2 (most improved groups) had the greatest mean score improvement on the CSD Total (Day 0 to Day 28), supporting responsiveness (similar findings for subscales). A change threshold of ⩾1.3-point reduction on the total and subscale scores is appropriate to define clinically meaningful improvement. CONCLUSION The CSD is a reliable, valid, and responsive measure of cough symptom severity in patients with refractory or unexplained chronic cough and fit-for-purpose for assessing changes in cough severity in clinical trials. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
| | | | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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14
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Wang Z, Wang M, Wen S, Yu L, Xu X. Types and applications of cough-related questionnaires. J Thorac Dis 2019; 11:4379-4388. [PMID: 31737324 DOI: 10.21037/jtd.2019.09.62] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cough is a normal protective reflex that can effectively remove foreign bodies and secretions from the airway. However, excessive cough adversely affects a patient's physiological, psychological and social functions. Thus, it is important to effectively evaluate the severity of cough to determine its diagnosis and treatment. Cough severity can be assessed with subjective or objective tools. Herein, we summarize the subjective evaluation of cough severity with questionnaires.
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Affiliation(s)
- Zhijing Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Miao Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Siwan Wen
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
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15
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Forestier B, Anthoine E, Reguiai Z, Fohrer C, Blanchin M. A systematic review of dimensions evaluating patient experience in chronic illness. Health Qual Life Outcomes 2019; 17:19. [PMID: 30665417 PMCID: PMC6341593 DOI: 10.1186/s12955-019-1084-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/07/2019] [Indexed: 12/23/2022] Open
Abstract
Background Living with a chronic disease often means experiencing chronic treatments and regular multidisciplinary monitoring as well as a profound life-changing experience which may impact all aspects of a patients life. The patient experience of chronic disease is frequently assessed by patient reported measures (PRMs) which incorporate patients perspectives to better understand how illness, treatment and care impact the entirety of a patient’s life. The purpose of this review was to collect and review different kinds of available PRM instruments validated for chronic patients, to produce an inventory of explored concepts in these questionnaires and to identify and classify all dimensions assessing chronic patients experience. Methods A systematic review of PRM instruments validated for chronic patients was conducted from three databases (Medline, the Cochrane library, and Psycinfo). Articles were selected after a double reading and questionnaires were classified according to their targeted concept. Then, all dimensions of the questionnaires were clustered into different categories. Results 107 primary validation studies of PRM questionnaires were selected. Five kinds of instruments were recorded: 1) Questionnaires assessing health related quality of life or quality of life; 2) Instruments focusing on symptoms and functional status; 3) Instruments exploring patients’ feelings and attitude about illness; 4) Questionnaires related to patients’ experience of treatment or healthcare; 5) Instruments assessing patients attitudes about treatment or healthcare. Twelve categories of dimensions were obtained from these instruments. Conclusions This review provided an overview of some of the dimensions used to explore chronic patient experience. A large PRM diversity exists and none of the reviewed and selected questionnaires covered all identified categories of dimensions of patient experience of chronic disease. Furthermore, the definition of explored concepts varies widely among researchers and complex concepts often lack a clear definition in the reviewed articles. Before attempting to measure chronic patient experience, researchers should construct appropriate instruments focusing on well-defined concepts and dimensions encompassing patient’s personal experience, attitude and adaptation to illness, treatment or healthcare. Electronic supplementary material The online version of this article (10.1186/s12955-019-1084-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bastien Forestier
- UMR U1246 SPHERE "methodS in Patient centered outcomes & HEalth REsearch", Université de Nantes, Université de Tours, INSERM, Nantes, France.,Pôle de santé publique, CHU de Nantes, Nantes, France
| | - Emmanuelle Anthoine
- UMR U1246 SPHERE "methodS in Patient centered outcomes & HEalth REsearch", Université de Nantes, Université de Tours, INSERM, Nantes, France.,Pôle de santé publique, CHU de Nantes, Nantes, France
| | - Ziad Reguiai
- Service de dermatologie, Polyclinique Courlancy, Reims, France
| | - Cécile Fohrer
- Service d'hématologie clinique, CHU de Strasbourg, Strasbourg, France
| | - Myriam Blanchin
- UMR U1246 SPHERE "methodS in Patient centered outcomes & HEalth REsearch", Université de Nantes, Université de Tours, INSERM, Nantes, France.
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16
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Abstract
PURPOSE OF REVIEW The review provides an overview of the results of asthma clinical trials published in peer review journals in the last 18 months that evaluated patient-reported outcomes (PROs). RECENT FINDINGS In the last 10 years, health care moved toward a patient-centered approach, which includes patients' perspectives reflecting the impact of a disease and its treatment. SUMMARY Surprisingly, among the almost 300 clinical trials published in the last one and a half year, PRO evaluation was performed in only 20 studies, and none of them held in a real-life setting. The effort of applying the scientific methods of PRO investigations in asthma clinical trials following a rigorous and systematic approach needs to be highly improved to allow better understanding of patient reported factors. Some recommendations are drawn particularly about PRO assessment in personalized medicine research. The ability of an individual PRO to evaluate choice of treatment and its effectiveness remains to be achieved.
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17
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Muñoz G, Buxó M, de Gracia J, Olveira C, Martinez-Garcia MA, Giron R, Polverino E, Alvarez A, Birring SS, Vendrell M. Validation of a Spanish version of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis. Chron Respir Dis 2016; 13:128-36. [PMID: 26902541 PMCID: PMC5734594 DOI: 10.1177/1479972316632005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The Leicester Cough Questionnaire (LCQ) has been validated in non-cystic fibrosis bronchiectasis (NCFBC). The present study aimed to create and validate a Spanish version of the LCQ (LCQ-Sp) in NCFBC. The LCQ-Sp was developed following a standardized protocol. For reliability, we assessed internal consistency and the change in score over a 15-day period in stable state. For responsiveness, we assessed the change in scores between visit 1 and the first exacerbation. For validity, we evaluated convergent validity through correlation with the Saint George's Respiratory Questionnaire (SGRQ) and discriminant validity. Two hundred fifty-nine patients (118 mild bronchiectasis, 90 moderate bronchiectasis and 47 severe bronchiectasis) were included. Internal consistency was high for the total scoring and good for the different domains (Cronbach's α: 0.86-0.91). The test-retest reliability shows an intraclass correlation coefficient of 0.87 for the total score. The mean LCQ-Sp score at visit 1 decreased at the beginning of an exacerbation (15.13 ± 4.06 vs. 12.24 ± 4.64; p < 0.001). The correlation between LCQ-Sp and SGRQ scores was -0.66 (p < 0.01). The differences in the LCQ-Sp total score between the different groups of severity were significant (p < 0.001). The LCQ-Sp discriminates disease severity, is responsive to change when faced with exacerbations and is reliable for use in bronchiectasis.
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Affiliation(s)
- Gerard Muñoz
- Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain Bronchiectasis Group, Girona Biomedical Research Institute, IDIBGI, Girona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute IDIBGI, Girona, Spain
| | - Javier de Gracia
- CIBER of Respiratory Diseases (Ciberes CB06/06/0030), Carlos III Health Institute, Spain Department of Pneumology, Vall d'Hebron University Hospital, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Casilda Olveira
- Department of Pneumology, Malaga Regional University Hospital, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Málaga, Spain
| | - Miguel Angel Martinez-Garcia
- CIBER of Respiratory Diseases (Ciberes CB06/06/0030), Carlos III Health Institute, Spain Department of Pneumology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Rosa Giron
- Department of Pneumology, Instituto de Investigación del Hospital de la Princesa, Madrid, Spain
| | | | - Antonio Alvarez
- CIBER of Respiratory Diseases (Ciberes CB06/06/0030), Carlos III Health Institute, Spain Department of Pneumology, Vall d'Hebron University Hospital, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, Denmark Hill Campus, King's College London, Denmark Hill, London, UK
| | - Montserrat Vendrell
- Bronchiectasis Group, Girona Biomedical Research Institute, IDIBGI, Girona, Spain CIBER of Respiratory Diseases (Ciberes CB06/06/0030), Carlos III Health Institute, Spain
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18
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Del Corral T, Percegona J, López N, Valiente A, Garriga M, Seborga M, Vilaró J. Validity of a Spanish Version of the Leicester Cough Questionnaire in Children With Cystic Fibrosis. Arch Bronconeumol 2015; 52:63-9. [PMID: 26163742 DOI: 10.1016/j.arbres.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/05/2015] [Accepted: 01/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) patients present chronic cough as one of the main symptoms, which has an important effect on quality of life and social relations. Our goal was to validate the Spanish version of the Leicester Cough Questionnaire (LCQ) in a group of children and teenagers with CF. METHODS After adapting to Spanish by standardized translation and retro-translation methodology, a sample of 58 stable CF patients from 7 to 18 years were recruited from three CF specialized centers in Spain. The questionnaire was administered twice; the second administration (LCQ2) was performed between 2-4 weeks later than the first one (LCQ1), in order to analyse the reliability and validity of the Spanish version. To correlate results with health related quality of life (HRQoL) we used the Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS Population was composed by 62% male, age 11.7 ± 3.1 years and body mass index (BMI) 19 ± 3 kg/m(2). Total scores from LCQ were: LCQ1 19 (17.75-21) vs LCQ2 19 (16-21) (P=.199). Cronbach's Alpha coefficient was 0.83 for the LCQtotal and for each specific domain was: 0.82 LCQphysical; 0.74 LCQpsychological and 0.62 LCQsocial. Intraclass correlation coefficient was: 0.69 LCQphysical; 0.59 LCQpsychological; 0.45 LCQsocial and 0.71 LCQtotal (good reliability). Relations with CFQ-R showed moderated and significant results: for the LCQtotal: respiratory symptom domain r = 0,51 (P<.001) and physical capacity domain r = 0,62 (P<.05). CONCLUSION The Spanish version of the Leicester Cough Questionnaire is reliable and valid for children and adolescents with CF and it has good relations with health related quality of life in this population.
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Affiliation(s)
- Tamara Del Corral
- Asociación Madrileña de Fibrosis Quística, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Janaína Percegona
- Máster en Medicina Respiratoria, Universitat de Barcelona y Universitat Pompeu Fabra, Barcelona, España
| | - Núria López
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - Andrea Valiente
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | | | - Melisa Seborga
- Asociación Madrileña de Fibrosis Quística, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Jordi Vilaró
- FCS Blanquerna, Grup de Recerca en Salut, Activitat Física i Esport (SAFE), Universitat Ramon Llull, Barcelona, España.
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Verduri A, Luppi F, D’Amico R, Balduzzi S, Vicini R, Liverani A, Ruggieri V, Plebani M, Barbaro MPF, Spanevello A, Canonica GW, Papi A, Fabbri LM, Beghè B. Antibiotic treatment of severe exacerbations of chronic obstructive pulmonary disease with procalcitonin: a randomized noninferiority trial. PLoS One 2015; 10:e0118241. [PMID: 25760346 PMCID: PMC4356612 DOI: 10.1371/journal.pone.0118241] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/07/2015] [Indexed: 12/19/2022] Open
Abstract
Background The duration of antibiotic treatment of exacerbations of COPD (ECOPD) is controversial. Serum procalcitonin (PCT) is a biomarker of bacterial infection used to identify the cause of ECOPD. Methods and Findings We investigated whether a PCT-guided plan would allow a shorter duration of antibiotic treatment in patients with severe ECOPD. For this multicenter, randomized, non-inferiority trial, we enrolled 184 patients hospitalized with ECOPD from 18 hospitals in Italy. Patients were assigned to receive antibiotics for 10 days (standard group) or for either 3 or 10 days (PCT group). The primary outcome was the rate of ECOPD at 6 months. Having planned to recruit 400 patients, we randomized only 183: 93 in the PCT group and 90 in the standard group. Thus, the completed study was underpowered. The ECOPD rate at 6 months between PCT-guided and standard antibiotic treatment was not significant (% difference, 4.04; 90% confidence interval [CI], −7.23 to 15.31), but the CI included the non-inferiority margin of 15. In the PCT-guided group, about 50% of patients were treated for 3 days, and there was no difference in primary or secondary outcomes compared to patients treated for 10 days. Conclusions Although the primary and secondary clinical outcomes were no different for patients treated for 3 or 10 days in the PCT group, the conclusion that antibiotics can be safely stopped after 3 days in patients with low serum PCT cannot be substantiated statistically. Thus, the results of this study are inconclusive regarding the noninferiority of the PCT-guided plan compared to the standard antibiotic treatment. The study was funded by Agenzia Italiana del Farmaco (AIFA-FARM58J2XH). Clinical trial registered with www.clinicaltrials.gov (NCT01125098). Trial Registration ClinicalTrials.gov NCT01125098
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Affiliation(s)
- Alessia Verduri
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
| | - Fabrizio Luppi
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
| | - Roberto D’Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena & Reggio Emilia, Modena, Italy
| | - Sara Balduzzi
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena & Reggio Emilia, Modena, Italy
| | - Roberto Vicini
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena & Reggio Emilia, Modena, Italy
| | - Anna Liverani
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | - Valentina Ruggieri
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | | | - Antonio Spanevello
- Department of Clinical and Experimental Medicine, Division of Pulmonary Rehabilitation, Fondazione S. Maugeri (Tradate), University of Insubria, Varese, Italy
| | | | - Alberto Papi
- Department of Respiratory Diseases, University of Ferrara, Ferrara, Italy
| | - Leonardo Michele Fabbri
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
- * E-mail:
| | - Bianca Beghè
- Department of Oncology, Haematology and Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
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Calabrese C, Tosco A, Abete P, Carnovale V, Basile C, Magliocca A, Quattrucci S, De Sanctis S, Alatri F, Mazzarella G, De Pietro L, Turino C, Melillo E, Buonpensiero P, Di Pasqua A, Raia V. Randomized, single blind, controlled trial of inhaled glutathione vs placebo in patients with cystic fibrosis. J Cyst Fibros 2015; 14:203-10. [DOI: 10.1016/j.jcf.2014.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Bonvini SJ, Birrell MA, Smith JA, Belvisi MG. Targeting TRP channels for chronic cough: from bench to bedside. Naunyn Schmiedebergs Arch Pharmacol 2015; 388:401-20. [PMID: 25572384 DOI: 10.1007/s00210-014-1082-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/16/2014] [Indexed: 12/24/2022]
Abstract
Cough is currently the most common reason for patients to visit a primary care physician in the UK, yet it remains an unmet medical need. Current therapies have limited efficacy or have potentially dangerous side effects. Under normal circumstances, cough is a protective reflex to clear the lungs of harmful particles; however, in disease, cough can become excessive, dramatically impacting patients' lives. In many cases, this condition is linked to inflammatory diseases such as asthma and chronic obstructive pulmonary disease (COPD), but can also be refractory to treatment and idiopathic in nature. Therefore, there is an urgent need to develop therapies, and targeting the sensory afferent arm of the reflex which initiates the cough reflex may uncover novel therapeutic targets. The cough reflex is initiated following activation of ion channels present on vagal sensory afferents. These ion channels include the transient receptor potential (TRP) family of cation-selective ion channels which act as cellular sensors and respond to changes in the external environment. Many direct activators of TRP channels, including arachidonic acid derivatives, a lowered airway pH, changes in temperature, and altered airway osmolarity are present in the diseased airway where responses to challenge agents which activate airway sensory nerve activity are known to be enhanced. Furthermore, the expression of some TRP channels is increased in airway disease. Together, this makes them promising targets for the treatment of chronic cough. This review will cover the current understanding of the role of the TRP family of ion channels in the activation of airway sensory nerves and cough, focusing on four members, transient receptor potential vanilloid (TRPV) 1, transient receptor potential ankyrin (TRPA) 1, TRPV4, and transient receptor potential melastatin (TRPM) 8 as these represent the channels where most information has been gathered with relevance to the airways. We will describe recent data and highlight the possible therapeutic utility of specific TRP channel antagonists as antitussives in the clinic.
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Affiliation(s)
- Sara J Bonvini
- Respiratory Pharmacology Group, Airway Disease Section, National Heart & Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
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Schmit KM, Coeytaux RR, Goode AP, McCrory DC, Yancy WS, Kemper AR, Hasselblad V, Heidenfelder BL, Sanders GD. Evaluating cough assessment tools: a systematic review. Chest 2014; 144:1819-1826. [PMID: 23928647 DOI: 10.1378/chest.13-0310] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Little is known about the comparative validity, reliability, or responsiveness of instruments for assessing cough frequency or impact, where the term impact encompasses both cough severity and the impact of cough on health-related quality of life. METHODS We conducted a systematic review to evaluate instruments that assess cough frequency or impact in adults, adolescents, and children with acute or chronic cough. RESULTS Seventy-eight studies were included, of which eight were randomized controlled trials and 70 were observational studies. In all age groups, audio and video electronic recording devices had good reliability compared with other methods of assessing cough frequency but had variable correlation with other cough assessments, such as visual analog scale scores, quality-of-life questionnaires, cough diaries, and tussigenic challenges. Among adult and adolescent patients, the Leicester Cough Questionnaire (LCQ) and the Cough-Specific Quality-of-Life Questionnaire (CQLQ) were valid and reliable, showing high intraclass and test-retest correlations. Among children, the Parent Cough-Specific Quality of Life Questionnaire and Pediatric Cough Questionnaire were valid and reliable. CONCLUSIONS Electronic recording devices can be valid assessments of cough frequency. The LCQ and CQLQ for adults and the Parent Cough-Specific Quality of Life questionnaire for children are valid instruments for assessing cough impact. There is limited but insufficient evidence to determine the reliability or concurrent validity of the different types of cough diaries or visual analog scale scores. There are also limited data to support the responsiveness of recording devices. There is good responsiveness data for the LCQ and CQLQ, but more evidence is needed.
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Affiliation(s)
- Kristine M Schmit
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.
| | - Remy R Coeytaux
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Adam P Goode
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Douglas C McCrory
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - Alex R Kemper
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Vic Hasselblad
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Brooke L Heidenfelder
- Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Gillian D Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
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Lai K, Pan J, Chen R, Liu B, Luo W, Zhong N. Epidemiology of cough in relation to China. COUGH 2013; 9:18. [PMID: 23835047 PMCID: PMC3711853 DOI: 10.1186/1745-9974-9-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/22/2013] [Indexed: 01/08/2023]
Abstract
Cough is one of the most common complaints for which patients seek medical attention. Misdiagnosis and mistreatment of cough exist commonly in China. The prevalence of acute cough caused by upper airway infection fluctuates between 9% and 64% in the community, for chronic cough, the prevalence >10% in most surveys, ranging from 7.2%-33%. The common causes of chronic cough are upper airway cough syndrome (previously called as post nasal drip syndrome [PNDS]), cough variant asthma (CVA), gastroesophageal reflux related cough (GERD) and eosinophilic bronchitis (EB). There is a regional discrepancy regarding the prevalence of common causes of cough and distribution of gender among China, UK, USA, the most common cause of chronic cough in China are CVA, followed by UACS, EB and atopic cough (AC), the male is almost equal to female in numbers in China. The risk factors for cough includes cold air, smoking, environmental pollutants, noxious substances and allergens, and unreasonable diet habits.
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Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Diseases, 1st Affiliated Hospital, Guangzhou Medical College, Guangzhou, GZ, China.
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Shembel AC, Rosen CA, Zullo TG, Gartner-Schmidt JL. Development and validation of the cough severity index: A severity index for chronic cough related to the upper airway. Laryngoscope 2013; 123:1931-6. [DOI: 10.1002/lary.23916] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Adrianna C. Shembel
- Department of Otolaryngology; University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine; Pittsburgh; Pennysylvania; U.S.A
| | - Clark A. Rosen
- Department of Otolaryngology; University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine; Pittsburgh; Pennysylvania; U.S.A
| | - Thomas G. Zullo
- Department of Otolaryngology; University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine; Pittsburgh; Pennysylvania; U.S.A
| | - Jackie L. Gartner-Schmidt
- Department of Otolaryngology; University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine; Pittsburgh; Pennysylvania; U.S.A
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Williams K, Frei A, Vetsch A, Dobbels F, Puhan MA, Rüdell K. Patient-reported physical activity questionnaires: a systematic review of content and format. Health Qual Life Outcomes 2012; 10:28. [PMID: 22414164 PMCID: PMC3349541 DOI: 10.1186/1477-7525-10-28] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 03/13/2012] [Indexed: 01/24/2023] Open
Abstract
Background Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations. Methods Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers. Results 104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories. Conclusions A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.
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Affiliation(s)
- Kate Williams
- Patient Reported Outcomes Centre of Excellence, Global Market Access, Primary Care Business Unit, Pfizer Ltd, Walton Oaks, Surrey, UK
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Berkhof FF, Boom LN, ten Hertog NE, Uil SM, Kerstjens HAM, van den Berg JWK. The validity and precision of the Leicester Cough Questionnaire in COPD patients with chronic cough. Health Qual Life Outcomes 2012; 10:4. [PMID: 22230731 PMCID: PMC3311606 DOI: 10.1186/1477-7525-10-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 01/09/2012] [Indexed: 11/27/2022] Open
Abstract
Background A validated instrument to assess the effects of chronic cough on health status in patients with chronic obstructive pulmonary disease (COPD) is currently not available. The Leicester Cough Questionnaire (LCQ) is a cough-specific health status questionnaire which is originally validated for a population of general patients presenting with chronic cough. We examined the psychometric performance of the LCQ in patients with COPD and chronic productive cough. Methods Concurrent validity, internal consistency, reproducibility and responsiveness were determined. The St. George's Respiratory Questionnaire (SGRQ) and the Short Form-36 (SF-36) were used as external criteria. Questionnaires were completed at the start of the study. After 2 and 12 weeks the LCQ was repeated, together with a global rating of change. Results In total 54 patients were included. Concurrent validity analysis showed significant correlations between corresponding domains of the LCQ and the SGRQ (rs -0.31 to -0.60). Corresponding domains of the LCQ and the SF-36 showed weaker correlations (rs 0.04 to 0.41). Internal consistency was adequate for two of the three domains (Cronbach's α 0.74 - 0.86). Test-retest reliability in stable patients was high (intraclass correlation coefficients 0.79 - 0.93). The mean difference after two weeks was 0.73 (± 1.75). Responsiveness analysis indicated that the LCQ was able to detect changes after 12 weeks. Conclusion The LCQ is a valid, reliable, responsive instrument to measure health status in COPD patients with chronic productive cough. Trial Registration ClinicalTrials.gov: NCT01071161
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Affiliation(s)
- Farida F Berkhof
- Isala klinieken, department of pulmonary diseases, Zwolle, The Netherlands.
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Frei A, Williams K, Vetsch A, Dobbels F, Jacobs L, Rüdell K, Puhan MA. A comprehensive systematic review of the development process of 104 patient-reported outcomes (PROs) for physical activity in chronically ill and elderly people. Health Qual Life Outcomes 2011; 9:116. [PMID: 22185607 PMCID: PMC3311097 DOI: 10.1186/1477-7525-9-116] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 12/20/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Capturing dimensions of physical activity relevant to patients may provide a unique perspective for clinical studies of chronically ill patients. However, the quality of the development of existing instruments is uncertain. The aim of this systematic review was to assess the development process of patient-reported outcome (PRO) instruments including their initial validation to measure physical activity in chronically ill or elderly patient populations. METHODS We conducted a systematic literature search of electronic databases (Medline, Embase, Psychinfo, Cinahl) and hand searches. We included studies describing the original development of fully structured instruments measuring dimensions of physical activity or related constructs in chronically ills or elderly. We broadened the population to elderly because they are likely to share physical activity limitations. At least two reviewers independently conducted title and abstract screening and full text assessment. We evaluated instruments in terms of their aim, items identification and selection, domain development, test-retest reliability, internal consistency, validity and responsiveness. RESULTS Of the 2542 references from the database search and 89 from the hand search, 103 full texts which covered 104 instruments met our inclusion criteria. For almost half of the instruments the authors clearly described the aim of the instruments before the scales were developed. For item identification, patient input was used in 38% of the instruments and in 32% adaptation of existing scales and/or unsystematic literature searches were the only sources for the generation of items. For item reduction, in 56% of the instruments patient input was used and in 33% the item reduction process was not clearly described. Test-retest reliability was assessed for 61%, validity for 85% and responsiveness to change for 19% of the instruments. CONCLUSIONS Many PRO instruments exist to measure dimensions of physical activity in chronically ill and elderly patient populations, which reflects the relevance of this outcome. However, the development processes often lacked definitions of the instruments' aims and patient input. If PROs for physical activity were to be used in clinical trials more attention needs to be paid to the establishment of content validity through patient input and to the assessment of their evaluative measurement properties.
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Affiliation(s)
- Anja Frei
- Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland
- Institute of General Practice and Health Services Research, University Hospital of Zurich, Switzerland
| | - Kate Williams
- Patient Reported Outcomes Centre of Excellence, Global Market Access, Primary Care Business Unit, Pfizer Ltd, Walton Oaks, Surrey, United Kingdom
| | - Anders Vetsch
- Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland
- Institute of General Practice and Health Services Research, University Hospital of Zurich, Switzerland
| | - Fabienne Dobbels
- Centre for Health Services and Nursing Research, post-doctoral researcher FWO Vlaanderen, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Laura Jacobs
- Respiratory Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katja Rüdell
- Patient Reported Outcomes Centre of Excellence, Global Market Access, Primary Care Business Unit, Pfizer Ltd, Walton Oaks, Surrey, United Kingdom
| | - Milo A Puhan
- Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore (MD), USA
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New concepts in the management of chronic cough. Pulm Pharmacol Ther 2011; 24:334-8. [PMID: 21255671 DOI: 10.1016/j.pupt.2011.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/31/2010] [Accepted: 01/12/2011] [Indexed: 02/04/2023]
Abstract
There has been significant progress in the field of cough in the past 10 years. Obstructive sleep apnoea, tonsillar enlargement and environmental fungi have recently been described as causes of chronic cough. The advances in the assessment of gastro-oesophageal reflux (GOR) have led to a greater understanding of the relationship between cough and GOR and are likely to change the approach to managing patients with GOR-cough. The investigation of the phenotype of patients with idiopathic chronic cough has provided novel insights. Patients with an idiopathic chronic are predominantly female, have an onset of cough around the menopause and have a high prevalence of organ specific autoimmune disease, particularly hypothyroidism. The presence of bronchoalveolar lymphocytosis suggests there is homing of inflammatory cells from primary sites of autoimmune inflammation to the lungs. A heightened cough reflex is a key feature of most patients with chronic cough and has led some investigators to suggest that chronic cough be recognised as a unique entity called Cough Hypersensitivity Syndrome (CHS). A number of subjective and objective tools have been developed recently to assess cough severity. Antitussive drug development is an emerging and exciting area of cough research.
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Birring SS. Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med 2010; 183:708-15. [PMID: 21148722 DOI: 10.1164/rccm.201007-1017ci] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic cough that cannot be explained after basic evaluation is a common reason for patients to be referred to respiratory outpatient clinics. Asthma, gastroesophageal reflux, and upper airway disorders frequently coexist with chronic cough. There is some controversy as to whether these conditions are causes or aggravants of cough. Heightened cough reflex sensitivity is an important feature in most patients. There is good evidence that it is reversible when associated with upper respiratory tract infection, angiotensin-converting enzyme inhibitor medications, and chronic cough associated with eosinophilic airway inflammation. In many patients, heightened cough reflex sensitivity is persistent and their cough is unexplained. There are few therapeutic options for patients with unexplained chronic cough. There is a pressing need to understand the genetic, molecular, and physiological basis of unexplained chronic cough and to develop novel antitussive drugs that down-regulate cough reflex sensitivity.
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Affiliation(s)
- Surinder S Birring
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill, London SE5 9RS, UK.
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Leconte S, Ferrant D, Dory V, Degryse J. Validated Methods of Cough Assessment: A Systematic Review of the Literature. Respiration 2010; 81:161-74. [DOI: 10.1159/000321231] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 08/29/2010] [Indexed: 11/19/2022] Open
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Braido F, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, La Grutta S, Lombardi C, Maurer M, Pinto AM, Ridolo E, Senna GE, Terreehorst I, Todo Bom A, Bousquet J, Zuberbier T, Baiardini I. Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: a GA(2)LEN taskforce position paper. Allergy 2010; 65:959-68. [PMID: 20486919 DOI: 10.1111/j.1398-9995.2010.02383.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The GA(2)LEN taskforce on Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) published in 2009 a position paper concerning PROS and HRQoL assessment in clinical trials on allergy. Because of the specificity of this topic in asthma and rhinitis, specific recommendations are needed. The aim of this position paper is to define PROs and their meaning in asthma and rhinitis research, explore the available tools to provide criteria for a proper choice, identify patient-related factor which could influence PROs assessment, define specific recommendations for assessment, analysis and results spreading, underline the unexplored areas and unmet needs. PROs assessment is gaining increasing importance, and it must be performed with a rigorous methodological procedure and using validated tools. This approach enables to better understand patient-related factors influencing clinical trials and real-life management outcomes, identify patients subgroups that can benefit from specific treatment and management plan and tailor treatment to address PROs (not only physician-defined targets) to improve asthma and rhinitis management.
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Affiliation(s)
- F Braido
- Allergy & Respiratory Disease Clinic, Ospedale S.Martino Genova, Genova, Italy.
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Measuring cough severity: development and pilot testing of a new seven-item cough severity patient-reported outcome measure. Ther Adv Respir Dis 2010; 4:199-208. [DOI: 10.1177/1753465810372526] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Although chronic and subacute cough are clinically problematic and a target of therapeutic interventions, there are no validated cough severity patient-reported outcome (PRO) instruments for comprehensively evaluating cough severity in clinical trials. The Cough Severity Diary (CSD) is a simple, seven-item daily diary developed to meet this need. The objective of this study was to assess preliminary measurement characteristics in a small sample of patients with chronic or subacute cough. Methods: Thirty-nine patients (24 chronic; 15 subacute) participated in a two-week prospective pilot study. Patients completed the CSD each evening and validation instruments (cough severity visual analog scale [VAS], Leicester Cough Questionnaire [LCQ], Medical Outcomes Study 36-Item Short Form [SF-36], Work Productivity Index [WPAI], MOS Sleep Scale [MOS-SS]) at baseline, days 8 and 15, and a global rating of change at days 8 and 15. Results: Confirmatory factor analyses supported three severity subscales: frequency (three items), intensity (two items), and disruption (two items) (χ2 = 10.57 (11)). For the CSD total score, internal consistency (α) on day 1 was 0.89, and on day 8 was 0.96; reproducibility (intraclass correlation coefficients [ICC]) was 0.68 on day 1 to day 8 and 0.94 on day 8 to day 15. CSD total scores correlated with the VAS (r = 0.84, p < 0.0001), LCQ total (r =-0.62, p < 0.0001) and subscale scores (r =-0.43, p < 0.01 to -0.60, p < 0.0001), and WPAI subscale scores (r = 0.27 (ns) to 0.51, p < 0.01). No significant relationships with SF-36 or MOS-SS were found. Subacute patients showed significant improvement over time (F = 3.20, p < 0.05). Conclusions: Results suggest that the CSD is ready for further testing in larger naturalistic studies or as an exploratory endpoint in clinical trials of patients with subacute or chronic cough.
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Abstract
Chronic cough is a relatively common symptom for which effective, acceptable treatments are lacking. Many patients suffer frequent coughing over several years without resolution and this has significant physical, social and psychological consequences. The recent development of cough-specific quality-of-life tools now allows quantification of the burden of coughing both in patients specifically presenting with chronic cough and also in common respiratory conditions.
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Affiliation(s)
- Emma C. Young
- North West Lung Research Centre, University Hospital South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Jaclyn A. Smith
- Respiratory Research Group, The University of Manchester, Manchester, UK
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Modulation of sensory nerve function and the cough reflex: understanding disease pathogenesis. Pharmacol Ther 2009; 124:354-75. [PMID: 19818366 DOI: 10.1016/j.pharmthera.2009.09.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 12/29/2022]
Abstract
To cough is a protective defence mechanism that is vital to remove foreign material and secretions from the airways and which in the normal state serves its function appropriately. Modulation of the cough reflex pathway in disease can lead to inappropriate chronic coughing and an augmented cough response. Chronic cough is a symptom that can present in conjunction with a number of diseases including chronic obstructive pulmonary disease (COPD) and asthma, although often the cause of chronic cough may be unknown. As current treatments for cough have proved to exhibit little efficacy and are largely ineffective, there is a need to develop novel, efficacious and safe antitussive therapies. The underlying mechanisms of the cough reflex are complex and involve a network of events, which are not fully understood. It is accepted that the cough reflex is initiated following activation of airway sensory nerves. Therefore, in the hope of identifying novel antitussives, much research has focused on understanding the neural mechanisms of cough provocation. Experimentally this has been undertaken using chemical or mechanical tussive stimuli in conjunction with animal models of cough and clinical cough assessments. This review will discuss the neural mechanisms involved in the cough, changes that occur under pathophysiological conditions and and how current research may lead to novel therapeutic opportunities for the treatment of cough.
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Vernon M, Leidy NK, Nacson A, Nelsen L. Measuring cough severity: Perspectives from the literature and from patients with chronic cough. COUGH 2009; 5:5. [PMID: 19298650 PMCID: PMC2669040 DOI: 10.1186/1745-9974-5-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 03/19/2009] [Indexed: 11/10/2022]
Abstract
Background In order to assess severity of cough from patients' perspectives and capture the effects of treatment in clinical trials, a measurement tool must show evidence of validity and reliability. The purpose of this study was to characterize cough severity from patients' perspectives as the initial step in the development of a new patient-reported outcome (PRO) measure for use in clinical trials. Methods This focus groups study included patients with clinician confirmed chronic cough recruited from a large internal medicine clinic in the US. A semi-structured focus group guide was designed to elicit information about patients' experiences with cough severity and their characterization of symptoms. The focus group data were coded to identify concepts and terminology of cough severity. Results Three focus groups were conducted [n = 22; 6 male; mean age 66.1 (± 12.9)]. Etiology included GERD, asthma, bronchitis, post-nasal drip, and other. Three domains of cough severity were identified: frequency, intensity, and disruption. In addition to a single cough, participants in all focus groups described coughing in uncontrollable paroxysms they called "fits," "bouts," "spells," or "episodes." The urge to cough, described as an important sign of impending cough, was considered a component of cough frequency. Participants also described daytime activity and nighttime sleep disruption as an indication of cough severity. Finally, participants described variability in cough severity. Conclusion Results suggest that patients describe cough severity in terms of frequency, intensity, and disruptiveness, indicating these 3 domains should be addressed when evaluating cough severity and outcomes of treatment.
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Braido F, Baiardini I, Balestracci S, Fassio O, Ravera S, Bellotti M, Canonica GW. The relationship between asthma control and quality-of-life impairment due to chronic cough: a real-life study. Ann Allergy Asthma Immunol 2008; 101:370-4. [PMID: 18939724 DOI: 10.1016/s1081-1206(10)60312-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of asthma therapy is to achieve optimal disease control and quality-of-life (QoL) improvements. Good correlation is reported between a composite evaluation of asthma control (the Asthma Control Test [ACT]) and QoL, with emphasis on asthma as a frequent cause of chronic cough and worsening of QoL due to chronic cough. OBJECTIVES To investigate asthma control in real life and to evaluate chronic cough-related impairment of QoL in patients with different degrees of asthma control evaluated by the ACT. METHODS Outpatients awaiting physician visits for asthma evaluation were asked to complete the ACT, the Chronic Cough Impact Questionnaire (CCIQ), and a rhinitis symptom score (Total Symptom Score [TSS] 5). RESULTS A total of 122 patients (mean [SD] age, 44 [15] years; age range, 15-75 years; 61.5% female) were enrolled in the study, of whom 74% reported rhinitis in conjunction with asthma. Overall asthma control was substantially less than optimal (ACT mean score, 14) in 44% of patients. Asthma control correlated to a limited degree with the CCIQ among the total sample. In patients with asthma alone, the correlation between the ACT and the CCIQ was much improved. In patients with comorbid rhinitis, only those with significant symptoms (as determined by the TSS5) reported using rhinitis treatment; among these, no significant correlation between the ACT and the CCIQ was found. CONCLUSIONS Asthma control in real life is less than optimal in substantially few patients. The importance of cough in asthma is highlighted by good correlation between cough and the ACT score in patients without comorbid rhinitis. In patients with comorbid rhinitis, cough appears related more to rhinitis than to asthma control. The combined use of the ACT and the CCIQ may be useful to improve asthma management, especially among patients in whom cough remains a prominent symptom.
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Affiliation(s)
- Fulvio Braido
- Allergy and Respiratory Diseases, DIMI, Genoa University, Genoa, Italy.
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Birring SS. Developing antitussives: the ideal clinical trial. Pulm Pharmacol Ther 2008; 22:155-8. [PMID: 19041729 DOI: 10.1016/j.pupt.2008.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/28/2008] [Indexed: 11/30/2022]
Abstract
Antitussive drugs are amongst the most widely used medications worldwide; however no new class of drugs have been introduced into the market for many years. Trials showing patient benefit are scarce and have been hampered by the lack of objective and validated outcome measures. Recent improvements in the assessment of cough will facilitate better trials and aid the development of antitussive drugs. When conducting a trial, patient selection is of paramount importance. Patients with unexplained chronic cough and sub-acute cough following upper respiratory tract infection are ideal because they represent an unmet clinical need and an untapped market for pharmaceutical companies. Patients with asthma and chronic obstructive pulmonary disease are less suitable since cough suppression is not always desirable and the findings of trials may not be generalisable to all patients with cough. Randomized, placebo-controlled, double-blind clinical trials are obviously the gold standard. The choice of placebo, whether inert or active, depends on the incidence and severity of drug side-effects. The primary outcome measure should be objective and cough monitors are the ideal tool. Subjective outcome measures should be used to assess symptoms and health related quality of life. Properly conducted clinical trials are an opportunity to evaluate the benefits of currently available therapies and aid advances in the antitussive drug market.
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Affiliation(s)
- Surinder S Birring
- Department of Respiratory Medicine, King's College Hospital, London, UK.
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Crawford B, Monz B, Hohlfeld J, Roche N, Rubin B, Magnussen H, Nivens C, Ghafouri M, McDonald J, Tetzlaff K. Development and validation of a cough and sputum assessment questionnaire. Respir Med 2008; 102:1545-55. [PMID: 18662868 DOI: 10.1016/j.rmed.2008.06.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 05/16/2008] [Accepted: 06/15/2008] [Indexed: 10/21/2022]
Abstract
Although cough and sputum production may impact patients' well being and functioning in COPD and chronic bronchitis, there is no validated instrument for cough and sputum symptoms and their impact on patients' daily activities. To fill that gap, we developed and validated a specific, multilingual Cough and Sputum Assessment Questionnaire (CASA-Q) that evaluates clinical symptoms and their impact on patients with COPD or chronic bronchitis. In a three-country validation study (n=671), there was adequate internal consistency (Cronbach's alphas, 0.80-0.91) and test-retest reliability (correlation coefficients>0.70) for the CASA-Q. The cough impact and sputum impact domains correlated with the SGRQ impact domain and SGRQ total score, as did the cough impact domain with the SF-36 social functioning domain. The cough symptom and sputum symptom domains correlated with sputum wet weight (p<0.05; r=-0.56), but not with cough recordings. The mean CASA-Q cough symptom and sputum symptom domain scores indicated responsiveness towards both worse and improved symptoms, whereas the impact domains scored already in the upper third of the scale range, indicating the need for further improvement of its properties. Differences in the CASA-Q domain scores by smoking status (current vs. former smokers) were highest for cough symptoms and lowest for sputum impact. These data indicate that the CASA-Q may be a useful measure of cough and sputum production, and their impact in patients with COPD and/or chronic bronchitis. Further validation will need to assess the responsiveness of the CASA-Q to changes in symptoms.
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Affiliation(s)
- Bruce Crawford
- Mapi Values, 15 Court Square, Suite 620, Boston, MA 02108, USA.
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Brignall K, Jayaraman B, Birring SS. Quality of life and psychosocial aspects of cough. Lung 2007; 186 Suppl 1:S55-8. [PMID: 17939003 DOI: 10.1007/s00408-007-9034-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 08/20/2007] [Indexed: 02/04/2023]
Abstract
Chronic cough is a common condition that causes considerable physical and psychological morbidity. The physical symptoms of cough are readily apparent; however, the psychosocial symptoms are often overlooked. Appreciation of the impact of cough on health-related quality of life has led to the development of three validated, cough-specific, health-related quality-of-life questionnaires that assess cough severity: Leicester Cough Questionnaire (LCQ), Cough-specific Quality of Life Questionnaire (CQLQ), and Chronic Cough Impact Questionnaire (CCIQ). These tools capture additional information not measured with objective tools and can be used to assess therapy. They should be used in conjunction with other cough severity measures such as cough frequency monitors to obtain a more complete assessment of cough severity. Recent cough guidelines endorse the measurement of cough-specific quality of life and these questionnaires are ideal tools to facilitate this.
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Affiliation(s)
- Kate Brignall
- Department of Respiratory Medicine, King's College Hospital, London, UK
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Abstract
OBJECTIVE To identify the factors that patients consider most concerning about their cough. PATIENTS AND METHODS All consecutive patients who presented with a complaint of chronic cough between November 1, 2000, and February 28, 2001, were prospectively surveyed for cough-related complaints using an 18-item symptom-complaint questionnaire. We analyzed frequencies of responses and response patterns to specific items on the questionnaire. We also examined whether the responses to individual items related to the patient's age, sex, and duration of cough. RESULTS Of the 146 consecutive patients referred for evaluation of chronic cough, 136 were eligible for inclusion in the study. These patients cited feelings of frustration, irritability, or anger (43%), frequent physician visits and testing (41%), and sleep disturbances (38%) as the most prevalent major problems. The responses to individual items on the questionnaire were not related to patients' age, sex, and cough duration. Anxiety about underlying serious illness continued to be a concern for most patients. CONCLUSIONS Frustration, anger, or anxiety was the most frequent major problem cited by patients. Frequent physician visits and testing was the unexpected second most frequent major problem. These findings are important because most chronic cough guidelines are based on clinical efficacy and cost-effectiveness considerations rather than on patient satisfaction. Future studies regarding chronic cough evaluation should take into account patient satisfaction and perceived burden of disease as outcome variables.
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Affiliation(s)
- Tomasz J Kuzniar
- Sleep Disorders Center, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Baiardini I, Braido F, Brandi S, Canonica GW. Allergic diseases and their impact on quality of life. Ann Allergy Asthma Immunol 2006; 97:419-28; quiz 429-30, 476. [PMID: 17069092 DOI: 10.1016/s1081-1206(10)60928-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review the results of studies that have evaluated the impact of allergic diseases on patients' health-related quality of life (HRQL). DATA SOURCES We performed a MEDLINE search of the literature published between January 1990 and May 2006 (English language only) on HRQL and allergic diseases. STUDY SELECTION Representative studies that used validated questionnaires that assessed the effect of allergic diseases on HRQL were selected for inclusion in this review. RESULTS Allergic diseases can deeply interfere with patients' HRQL, with detrimental effects on the physical, psychological, and social dimensions of life. Numerous validated questionnaires that are now available can easily be adopted; most of them are specifically developed for rhinitis and asthma. CONCLUSIONS HRQL has become an increasingly important aspect in outcome evaluation in health care research, providing a more comprehensive approach to the patient and proving that nowadays we cannot renounce this tool. Most of the studies evaluate patients with respiratory allergy. Further studies are needed to explore HRQL in other allergic conditions (urticaria, food allergy, sting allergy, drug allergy) by means of specific, validated questionnaires.
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Affiliation(s)
- Ilaria Baiardini
- Allergy and Respiratory Diseases, DIMI, Genoa University, Genoa, Italy
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Abstract
Sleep is fundamental for physical and mental health as well as daytime performance and represents a crucial aspect in the personal representations of well-being. Sleep disturbances in patients with chronic disorders constitute a factor that contributes to exacerbate symptoms, complicate management, and affect mood and quality of life (QoL). Allergic diseases are a global health problem of increasing prevalence that affects up to 15% of the population in Western countries. Sleep problems associated with allergic diseases may play a role in worsening the burden of illness, contributing to impairment of the QoL. The aim of this review was to describe the most common causes leading to sleep disturbance in allergic patients and their consequences on the QoL. The possible negative effects of treatment on sleep parameters has been also considered.
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Affiliation(s)
- I Baiardini
- Allergy and Respiratory Diseases, DIMI, Genoa University, Genoa, Italy
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Raj AA, Birring SS. Clinical assessment of chronic cough severity. Pulm Pharmacol Ther 2006; 20:334-7. [PMID: 17113330 DOI: 10.1016/j.pupt.2006.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2006] [Accepted: 10/04/2006] [Indexed: 11/28/2022]
Abstract
The assessment of cough severity solely through consultation with the patient is limited by its subjective nature and variability of physician judgement. The assessment of cough has been hampered by a paucity of objective tools, those available have been poorly validated, non-standardized and are impractical for clinical use. Recent developments have overcome some of these problems and a variety of tools can now be used to assess cough that include visual analogue scales (VAS), quality-of-life questionnaires, cough reflex sensitivity measurement and automated cough frequency monitors. These tools can be used to validate the presence of cough and assess response to therapy. They will also have an important role in clinical trials.
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Affiliation(s)
- Anita A Raj
- Department of Respiratory Medicine, King's College Hospital, London SE5 9RS, UK
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Whalley S, McManus IC. Living with primary ciliary dyskinesia: a prospective qualitative study of knowledge sharing, symptom concealment, embarrassment, mistrust, and stigma. BMC Pulm Med 2006; 6:25. [PMID: 17040569 PMCID: PMC1635565 DOI: 10.1186/1471-2466-6-25] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 10/13/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a chronic respiratory disease for which there is little psycho-social research and no qualitative studies of individuals living with the condition. A questionnaire-based survey in 2003 found evidence of stigmatisation in some individuals with PCD. Although the questionnaire had face and construct validity, stigmatisation was not cross-validated against interviews. The present study had the twin aims of carrying out a qualitative study of the adult patients living with PCD, and using a structured design to validate the questionnaire measure of stigma. METHODS Interviews were carried out with six pairs of individuals with PCD, matched for sex, situs, and age, one with a high stigma score in 2003 and the other with a low stigma score. Depth-qualitative interviews were conducted by one author to explore themes surrounding the psycho-social impact of PCD using a grounded theory analysis. The interviewer was blind to the stigma scores of participants, and after the qualitative analysis was completed, the interviewer made an assessment of which member of each pair seemed the more stigmatised, after which the code was broken. RESULTS Interviews revealed a number of themes, including other people's knowledge of PCD, the sharing of knowledge about PCD, the concealment of symptoms of PCD, embarrassment at symptoms, changes of behaviour in response to PCD, mistrust of medical care, in particular in relation to problems in diagnosis, a mistrust of general practitioners who were seen as poorly informed, and the importance of expert care at tertiary referral centres. Although stigmatisation as such was rarely mentioned directly by respondents, when the interviewer's judgement on level of stigmatisation was correlated with stigma scores from 2003, it was found that the more stigmatised member had been correctly identified in all six pairs (p = .016). CONCLUSION Our results suggest that some people with PCD feel isolated through mistrust in medicine, and lack of knowledge surrounding PCD. Many responses to PCD can be explained in terms of stigmatisation, and in particular felt stigma. The correlation between questionnaire used several years previously, and the interviewer's judgements of stigmatisation suggest that the stigma questionnaire had both predictive validity and long-term stability. As in other chronic conditions, stigmatisation occurs only in some individuals with PCD, and the present study explores the basis of stigmatisation, and validate the questionnaire as a measure of difference in stigma.
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Affiliation(s)
- Simon Whalley
- Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - IC McManus
- Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK
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Chung KF. Measurement of cough. Respir Physiol Neurobiol 2006; 152:329-39. [PMID: 16530025 DOI: 10.1016/j.resp.2006.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/31/2006] [Accepted: 02/01/2006] [Indexed: 11/26/2022]
Abstract
Cough is one of the most common symptoms encountered by clinicians particularly when it is persistent. Assessment of cough is essential for determining treatment outcomes, testing new therapies and for study of pathophysiology and mechanisms. There are new tools for measuring different aspects of cough. Apart from the patient's subjective assessment of cough severity using clinical scores, the impact of cough on quality of life can be measured. Direct measurement of cough counts is now possible by using portable devices, but how the counts relate to severity is unclear. A measure of cough intensity is required. Cough reflex measured by response to inhaling citric acid or capsaicin provides a measure of cough sensitivity that may be related to cough severity. In many intervention studies of cough, the response has usually been measured in terms of physician assessment of cough and its changes in cough reflex. How the information obtained between these different measurements interrelate needs to be determined.
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Affiliation(s)
- K F Chung
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, Dovehouse Street, London SW3 6LY, UK.
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Current World Literature. Curr Opin Allergy Clin Immunol 2006; 6:67-9. [PMID: 16505615 DOI: 10.1097/01.all.0000202355.95779.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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