Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ)

Abstract

Background: Chronic cough is a common condition which has a significant impact on quality of life. Assessment and management are hampered by the absence of well validated outcome measures. The development and validation of the Leicester Cough Questionnaire (LCQ), a self-completed health related quality of life measure of chronic cough, is presented. Methods: Patients with chronic cough were recruited from outpatient clinics. The development of the LCQ consisted of three phases: phase 1 (item generation); phase 2 (item reduction, allocation of items to domains and validation of questionnaire); phase 3 (repeatability and responsiveness testing of final version of questionnaire). Results: Phase 1: Literature review, multidisciplinary team meeting and 15 structured interviews with chronic cough patients generated 44 items (LCQ1) with a 7 point Likert response scale. Phase 2: 104 chronic cough outpatients completed the LCQ1 along with an importance rating for each item. The clinical impact factor method was used for item reduction to 19 items (LCQ2: final version). These items were divided into three domains (physical, psychological and social) following expert opinion. Internal reliability, as assessed using Cronbach's alpha coefficients, varied between 0.79 and 0.89. Concurrent validity was high when the LCQ2 (n=56) was compared with a cough visual analogue score (r=-0.72). There was a moderate relationship with response to the St George's Respiratory Questionnaire (r=-0.54) and SF36 total score (r=0.46). Phase 3: Two week repeatability (n=24) was high with intraclass correlation coefficients for domains varying between 0.88 and 0.96. Responsiveness in nine patients whose cough was successfully treated varied within domains from an effect size of 0.84 to 1.75. Conclusion: The LCQ is a valid, repeatable 19 item self-completed quality of life measure of chronic cough which is responsive to change. It should be a useful tool in clinical trials and longitudinal studies. C hronic cough is one of the most common causes of presentation to general practice. At any one time 20% of the UK population have a troublesome cough and sufferers consume 75 million doses of over the counter antitussive medications annually.1 Most cases are acute and self-limiting, although a significant minority are referred for a specialist opinion with an isolated persistent chronic cough. 2These patients suffer considerable physical and psychological morbidity. 3The assessment of health status is increasingly important in respiratory disease and has been extensively studied in asthma and chronic obstructive pulmonary disease by development of disease specific questionnaires.4 5 Very little is known about the effects of chronic cough on health status because of the lack of such validated questionnaires. Indeed, there is a striking paucity of objective and well validated outcome measures in chronic cough. Our aims were to develop a health related quality of life questionnaire specifically for chronic cough that is brief, simple to administer and sco...

An update and systematic review on drug therapies for the treatment of refractory chronic cough

“…Chronic cough (CC) is common and is associated with decreased quality of life [1]. Common causes of CC are asthma, gastroesophageal reflux disease (GERD), and upper airway disorders such as postnasal drip syndrome and rhinosinusitis.…”

“…The most widely used tests include the visual analog scale (VAS) for cough [70,71] because it is simple and practical, the Leicester Cough Questionnaire (LCQ) [1] and Cough Quality of Life Questionnaire (CQLQ) [72] are all well validated for assessing the impact of cough on health status [73]. The Cough Severity Index (CSI) is a validated a severity index for CC related to the upper airway [74].…”

Are there clinical features of a sensitized cough reflex?

“…This airway sensory hyperreactivity (SHR) is often what disturb patients most about their condition and appears to be of sufficient importance to impact on health status [3]. In the development of the two most widely used cough quality of life questionnaires items most frequently perceived as important by cough patients included statements such as; 'exposure to paint or fumes made me cough' [4]and 'I can no longer sing, for example, in church' [5].…”

Reliability and validity of Leicester Cough Questionnaire Korean version

“…6 One bilingual physician translated the English version of LCQ into Korean, and the translation panel reviewed the translation and prepared for a Korean draft (version 1). The other bilingual physician, blind to the original English version, back translated the Korean draft into English.…”

“…5 However, components of these studies only concern symptoms but not the psychological or social disturbances, and the quality of life is not considered. In 2001, Birring et al developed Leicester Cough Questionnaire (LCQ) consisting of three parts, 6 namely physiological, psychological, and social, which score patient's quality of life. In 2007, LCQ Dutch version (LCQ-D) was developed and assessed with respect to the reliability and validity.…”