Cough-specific Quality Of Life Questionnaire Research Articles

Clinical Outcomes After Tracheobronchoplasty With Ringed Polytetrafluoroethylene Vascular Graft

BackgroundThis report describes the surgical technique and outcomes of tracheobronchoplasty (TBP) with ringed polytetrafluoroethylene (PTFE) vascular graft. MethodsWe identified all patients who underwent PTFE-TBP for severe expiratory central airway collapse from January 1, 2018 to August 2021 at Mayo Clinic, Florida. Preoperative and postoperative St George’s Respiratory Questionnaire (SGRQ), Cough-Specific Quality of Life Questionnaire (CSQLQ), pulmonary function testing, 6-minute walk test, and blinded dynamic bronchoscopy videos at 3-month follow-up were used to assess outcomes. ResultsFourteen patients (median age, 62.5 years; 64.3% female) underwent PTFE-TBP. The median operative time was 355 minutes, median hospital length of stay was 5 days, and median intensive care unit stay was 1 day. One patient had a Clavien-Dindo grade ≥3 complication. Comparison of preoperative and postoperative questionnaire scores demonstrated improvement in median SGRQ score by 14.79 (P = .013) and CSQLQ score by 22 (P = .005). Preoperative and postoperative pulmonary function and 6-minute walk test results showed no significant difference. Postoperative bronchoscopy demonstrated improvement in median collapsibility of mid trachea by 39.6% (P < .001), distal trachea by 50% (P < .001), left main bronchus by 38.2% (P < .001), right main bronchus by 37.9% (P < .001), and bronchus intermedius by 30.7% (P < .001). ConclusionsPTFE-TBP provides significant improvement in patients' symptoms and expiratory central airway collapse as judged by preoperative and postoperative quality of life questionnaires and bronchoscopy.

Chronic cough-the limitation and advances in assessment techniques.

Accurate and consistent assessments of cough are essential to advance the understanding of the mechanisms of cough and individualised the management of patients. Considerable progress has been made in this work. Here we reviewed the currently available tools for subjectively and objectively measuring both cough sensitivity and severity. We also provided some opinions on the new techniques and future directions. The simple and practical Visual Analogue Scale (VAS), the Leicester Cough Questionnaire (LCQ), and the Cough Specific Quality of Life Questionnaire (CQLQ) are the most widely used self-reported questionnaires for evaluating and quantifying cough severity. The Hull Airway Reflux Questionnaire (HARQ) is a tool to elucidate the constellation of symptoms underlying the diagnosis of chronic cough. Chemical excitation tests are widely used to explore the pathophysiological mechanisms of the cough reflex, such as capsaicin, citric acid and adenosine triphosphate (ATP) challenge test. Cough frequency is an ideal primary endpoint for clinical research, but the application of cough counters has been limited in clinical practice by the high cost and reliance on aural validation. The ongoing development of cough detection technology for smartphone apps and wearable devices will hopefully simplify cough counting, thus transitioning it from niche research to a widely available clinical application.

A NOVEL, DEEP-LEARNING ALGORITHM TO DETECT COUGH USING COMPUTER-AIDED AUSCULTATION (COUGH-CAAE)

A NOVEL, DEEP-LEARNING ALGORITHM TO DETECT COUGH USING COMPUTER-AIDED AUSCULTATION (COUGH-CAAE)

Tracheobronchoplasty yields long-term anatomy, function, and quality of life improvement for patients with severe excessive central airway collapse

ObjectivesThis study examines the long-term anatomic and clinical effects of tracheobronchoplasty in severe excessive central airway collapse. MethodsIncluded patients underwent tracheobronchoplasty for excessive central airway collapse (2002-2016). The cross-sectional area of main airways on dynamic airway computed tomography was measured before and after tracheobronchoplasty. Expiratory collapse was calculated as the difference between inspiratory and expiratory cross-sectional area divided by inspiratory cross-sectional area ×100. The primary outcome was improvement in the percentage of expiratory collapse in years 1, 2, and 5 post-tracheobronchoplasty. Secondary outcomes included mean response profile for the 6-minute walk test, Cough-Specific Quality of Life Questionnaire, Karnofsky Performance Status score, and St George Respiratory Questionnaire. Repeated-measures analysis of variance was used for statistical analyses. ResultsThe cohort included 61 patients with complete radiological follow-up at years 1, 2, and 5 post-tracheobronchoplasty. A significant linear decrease in the percentage of expiratory collapsibility of the central airways after tracheobronchoplasty was present. Anatomic repair durability was preserved 5 years after tracheobronchoplasty, with decrease in percentage of expiratory airway collapse up to 40% and 30% at years 1 and 2, respectively. The St George Respiratory Questionnaire (74.7 vs 41.8%, P < .001) and Cough-Specific Quality of Life Questionnaire (78 vs 47, P < .001) demonstrated significant improvement at year 5 compared with baseline. Similar results were observed in the 6-minute walk test (1079 vs 1268 ft, P < .001) and Karnofsky score (57 vs 82, P < .001). ConclusionsTracheobronchoplasty has durable effects on airway anatomy, functional status, and quality of life in carefully selected patients with severe excessive central airway collapse.

Prevalence and impact of airway diseases on clinical outcomes in idiopathic pulmonary fibrosis.

Background/AimsThe prevalence and effects of airway diseases, including asthma, eosinophilic bronchitis (EB), chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) have not been thoroughly studied in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to evaluate the prevalence of airway diseases in patients with IPF and to identify the differences in symptoms based on the presence of airway diseases.MethodsThis single-institution prospective cohort study was conducted from June 2017 to September 2018, at the Seoul National University Hospital. Spirometry with bronchodilator, methacholine bronchial provocation test, induced sputum with eosinophil stain, and exhaled nitric oxide were performed to confirm the presence of airway disease. The modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), St. George’s Respiratory Questionnaire (SGRQ), EuroQol-5 dimension (EQ-5D) index, and cough-specific quality of life questionnaire (CQLQ) data were collected to assess symptom severity.ResultsTotal 147 patients with IPF were screened, and 70 patients were analyzed. The prevalence of airway diseases in the participants was as follows: 5.0% had COPD, 1.7% had asthma, 3.3% had ACO, and 1.7% had EB. The mMRC, CAT, SGRQ, EQ-5D, and CQLQ scores did not differ regardless of combined airway disease. After 3 months, the SGRQ (p = 0.028) and CQLQ (p = 0.030) scores were significantly higher in patients with airway disease than in those without.ConclusionsThe prevalence of airway diseases in patients with IPF is low, but when airway diseases are accompanied by IPF, symptom severity and quality of life may worsen rapidly.

Children's Acute Cough-Specific Quality of Life: Revalidation and Development of a Short Form.

Acute cough in children has a significant impact on the child and family. Relevant quality of life (QoL) instruments are essential for high-quality clinical research. This study aimed to (1) revalidate the 16-item Parent-proxy Children's Acute Cough-specific QoL questionnaire (PAC-QoL16) using a different dataset (i.e., different children), (2) confirm the minimally important difference (MID), and (3) develop and validate a short form. Three datasets from two sources were utilized, comprising of 332 children with acute cough (< 2weeks duration); the first dataset (n = 83, 54 boys; median age 2.04years, IQR 1.08-4.06years) was used for revalidation, the second dataset (n = 238, 141 boys; median age 2.17years, IQR 1.21-4.21years) was used to develop the short form, and the third dataset (n = 94, 62 boys; median age, 1.75years, IQR 0.90-3.63years) was used to confirm the short form. Psychometric properties were investigated. Six items were found to account for 96.4% of the variance in the PAC-QoL16. The PAC-QoL16 and short form (PAC-QoL6) scales correlated with cough scores (rs ≤ -0.40, p < 0.001), were internally consistent (Cronbach α = 0.94 and 0.87, respectively) and demonstrated sensitivity to change over time. A MID of 0.71 to 1.11 is recommended. Both the PAC-QoL16 and newly developed short form (PAC-QoL6) are reliable and valid outcome measures that assess children's acute cough-specific QoL at a given time point, are easy to interpret and reflect changes over time. The new short form addresses the need for outcome measures to be as time effective as possible without loss of information.

Obese Patients Undergoing Tracheobronchoplasty Have Excellent Outcomes

BackgroundTracheobronchoplasty (TBP) is the gold-standard treatment for severe symptomatic excessive central airway collapse; however outcomes among obese patients are unknown. MethodsA retrospective, single-center analysis was conducted on consecutive patients undergoing TBP for severe symptomatic excessive central airway collapse from 2003 to 2020. Demographics, comorbidities, functional status, and perioperative complications were collected. Functional status was assessed with a 6-minute walk test (6MWT). Health-related quality of life (HRQOL) was assessed with the St George’s Respiratory Questionnaire (SGRQ), Cough-specific Quality of Life Questionnaire, and modified Medical Research Council dyspnea scale (mMRC) at baseline and postoperatively. Wilcoxon rank-sum and χ2 tests were used to compare outcomes between groups. A mixed-effects regression model compared 6MWT and HRQOL over time. ResultsOne hundred three patients underwent TBP with complete follow-up data. Thirty-four patients (33%) were obese (body mass index ≥ 35 kg/m2). Baseline demographics were similar between obese and nonobese groups, but obese patients had worse preoperative SGRQ and mMRC scores. Overall complication rates were similar (52.9% vs 43.5%, P = .36). At 3 months there was no significant difference in SGRQ, Cough-specific Quality of Life Questionnaire, or 6MWT scores; however mMRC scores were higher in obese patients (P = .04). At 12 months there was no significant difference in SGRQ, Cough-specific Quality of Life Questionnaire, mMRC, or 6MWT scores. Correcting for age, sex, and Charlson Comorbidity Index a mixed-effects regression model demonstrated obesity was not an independent predictor for lower 6MWT scores or HRQOL. ConclusionsObese patients achieve similar improvement in HRQOL and functional capacity with comparable morbidity after TBP as nonobese patients. Obesity should not preclude patients with severe symptomatic excessive central airway collapse from TBP.

Gender difference in the association between cough severity and quality of life among patients with postinfectious cough

BackgroundDespite 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.MethodsSecondary 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.ResultsDifference 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).ConclusionsFemale 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.

Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis

Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent’s quality of life was assessed as secondary outcome. In 36 children (2–8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children’s Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed.What is Known:• Cough and wheezing are the predominant symptoms of acute bronchitis.• There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies.What is New:• Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.

Longitudinal study of quality of life among children with acute respiratory infection and cough.

Acute respiratory infections (ARIs), and associated symptoms such as cough, are frequently experienced among children and impose a burden on families (e.g., use of medical resources and time off work/school). However, there are little data on changes in, and predictors of, quality of life (QoL) over the duration of an ARI with cough (ARIwC) episode. We therefore aimed to determine cough-specific QoL and identify its influencing factors among children with ARIwC, at the time of presentation to a pediatric emergency department (ED), and over the following 4 weeks. Data from 283 children aged < 15years were included in our analyses. We used the validated parent-proxy children's acute cough-specific QoL questionnaire (PAC-QoL) at each time-point. Linear regression and mixed effect modeling were used to identify factors influencing QoL at baseline and over the follow-up period. Median PAC-QoL at baseline was 2.7 (IQR 2.1-3.6) and significantly improved by Day-7 (4.9, IQR 3.8-6.1) and Day-14 (6.59, IQR 5.1-7.0), both p < 0.001. The improvements in median PAC-QoL between Days-14, -21, and -28 were not significant. Regression modeling identified that day-cough severity, night-cough severity, and financial concerns had the highest impact on both baseline, and follow-up, PAC-QoL scores. There were five additional independent significant factors at baseline and six at follow-up. Quality of life is considerably impaired at presentation to ED, but improves significantly by Days-7 and -14. As cough severity and financial concerns had the highest impact on QoL, effectively managing cough to reduce the clinical and financial burden on children and families is important.

The efficacy of QingfengGanke granule in treating postinfectious cough in pathogenic wind invading lungs syndrome: a multicenter, randomized, double-blind, placebo-controlled trial.

BackgroundPostinfectious cough (PIC) significantly affects cough-related quality of life but still lacks effective treatments. This study aims to investigate the efficacy of QingfengGanke granule (QFGKG) in treating PIC induced by pathogenic wind invading lungs syndrome.MethodsA multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted. A total of 180 eligible participants were randomly (1:1:1) assigned to group A (QFGKG 6 g plus QFGKG-matched placebo 6 g), group B (QFGKG 12 g), and group C (QFGKG-matched placebo 12 g). All herbal medications were orally administered twice daily for 10 consecutive days. The primary outcome was time to cough resolution, and secondary outcomes included time to cough alleviation, mean changes in cough symptom score (CSS), visual analogue scale (VAS) score, cough-specific quality of life questionnaire (CQLQ) score, and traditional Chinese medicine (TCM) syndrome score from baseline to Day 10, as well as adverse events.ResultsA total of 173 participants were included in the efficacy and safety analyses (group A, n = 57; group B, n = 57; group C, n = 59). The median time to cough resolution in groups A, B, and C was more than 10 days, 8 days, and more than 10 days, respectively (P < 0.0001), and the median time to cough alleviation was 4, 4, and 6 days, respectively (P < 0.0001). Compared with the placebo condition, groups A and B showed significantly greater improvements in CSS (P = 0.0005, P < 0.0001, respectively), VAS (P = 0.0002, P < 0.0001, respectively), CQLQ (P = 0.0258, P = 0.0003, respectively), and TCM syndrome (P = 0.0031, P < 0.0001, respectively). The time to cough resolution was faster in group B compared with group A (P = 0.0091). The adverse event profiles were comparable among the three groups.ConclusionQingfengGanke granule is efficacious in the treatment of PIC induced by pathogenic wind invading lungs syndrome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13020-015-0049-6) contains supplementary material, which is available to authorized users.

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

Since the publication of the 2006 American College of Chest Physicians (CHEST) cough guidelines, a variety of tools has been developed or further refined for assessing cough. The purpose of the present committee was to evaluate instruments used by investigators performing clinical research on chronic cough. The specific aims were to (1) assess the performance of tools designed to measure cough frequency, severity, and impact in adults, adolescents, and children with chronic cough and (2) make recommendations or suggestions related to these findings. By following the CHEST methodologic guidelines, the CHEST Expert Cough Panel based its recommendations and suggestions on a recently published comparative effectiveness review commissioned by the US Agency for Healthcare Research and Quality, a corresponding summary published in CHEST, and an updated systematic review through November 2013. Recommendations or suggestions based on these data were discussed, graded, and voted on during a meeting of the Expert Cough Panel. We recommend for adults, adolescents (≥ 14 years of age), and children complaining of chronic cough that validated and reliable health-related quality-of-life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough, such as the Leicester Cough Questionnaire and the Cough-Specific Quality-of-Life Questionnaire in adult and adolescent patients and the Parent Cough-Specific Quality of Life Questionnaire in children. We recommend acoustic cough counting to assess cough frequency but not cough severity. Limited data exist regarding the performance of visual analog scales, numeric rating scales, and tussigenic challenges. Validated and reliable cough-specific health-related QoL questionnaires are recommended as the measurement of choice to assess the impact of cough on patients. How they compare is yet to be determined. When used, the reporting of cough severity by visual analog or numeric rating scales should be standardized. Previously validated QoL questionnaires or other cough assessments should not be modified unless the new version has been shown to be reliable and valid. Finally, in research settings, tussigenic challenges play a role in understanding mechanisms of cough.

Is your cough getting better?

Is your cough getting better?

An acute cough-specific quality-of-life questionnaire for children: Development and validation

Patient-relevant outcome measures are essential for high-quality clinical research, and quality-of-life (QoL) tools are the current standard. Currently, there is no validated children's acute cough-specific QoL questionnaire. The objective of this study was to develop and validate the Parent-proxy Children's Acute Cough-specific QoL Questionnaire (PAC-QoL). Using focus groups, a 48-item PAC-QoL questionnaire was developed and later reduced to 16 items by using the clinical impact method. Parents of children with a current acute cough (<2 weeks) at enrollment completed 2 validated cough score measures, the preliminary 48-item PAC-QoL, and 3 other questionnaires (the State Trait Anxiety Inventory [STAI], the Short-Form 8-item 24-hour recall Health Survey [SF-8], and the Depression, Anxiety, and Stress 21-item Scale [DASS21]). All measures were repeated on days 3 and 14. The median age of the 155 children enrolled was 2.3 years (interquartile range, 1.3-4.6). Median cough duration at enrollment was 3 days (interquartile range, 2-5). The reduced 16-item scale had high internal consistency (Cronbach α = 0.95). Evidence for repeatability and criterion validity was shown by significant correlations between the domains and total PAC-QoL scores and the SF-8 (r = -0.36 and -0.51), STAI (r = -0.27 and -0.39), and DASS21 (r = -0.32 and -0.41) scales on days 0 and 3, respectively. The final PAC-QoL questionnaire was sensitive to change over time, with changes significantly relating to changes in cough score measures (P < .001). The 16-item PAC-QoL is a reliable and valid outcome measure that assesses QoL related to childhood acute cough at a given time point and reflects changes in acute cough-specific QoL over time.

An update on measurement and monitoring of cough: what are the important study endpoints?

Considerable progress has been achieved in the development of tools that assess cough. The visual analogue scale (VAS) for cough severity is widely used in clinical practice because it's simple and practical. The Leicester cough questionnaire (LCQ) and the cough-specific quality of life questionnaire (CQLQ) are the most widely used health status questionnaires for adults with chronic cough. They are well validated for assessing the impact of cough. Cough can be assessed objectively with challenge tests that measure the sensitivity of the cough reflex. Cough challenge tests are better used to determine the mechanism of action of therapy, rather than efficacy. Cough frequency monitoring, the preferred tool to objectively assess cough, is increasingly being used as primary end-points in clinical trials. The most widely used cough monitors are the Leicester cough monitor (LCM) and VitaloJak. They are ambulatory devices that consist of a microphone and recording device. Cough frequency monitors do not reflect the intensity or the impact of cough; hence their relationship with subjective measures of cough is weak. Cough should therefore be assessed with a combination of subjective and objective tools. There is a paucity of studies that have investigated the minimal important difference of cough frequency monitors, rendering further investigations needed.

Evaluating Cough Assessment Tools: A Systematic Review

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. We conducted a systematic review to evaluate instruments that assess cough frequency or impact in adults, adolescents, and children with acute or chronic cough. 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. 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.

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

To develop and validate a cough severity index (CSI) which quantifies patients' symptoms associated with upper airway chronic cough and to provide a tool for treatment outcome measures. Two hundred patients who had a complaint of chronic cough and/or dyspnea were given a 49- item questionnaire developed through a clinical consensus of the most common symptoms of chronic cough of upper airway origin. The instrument was reduced to 10 questions using statistical methodology. Fifty subsequent patients were given the CSI to measure test-retest reliability at two different moments in time. Twenty healthy controls (HC) were given the instrument to obtain validity. An additional 95 participants provided pre- and posttreatment outcomes using the CSI. Principle Component Analysis (PCA) revealed a single factor with the original 49 questions. A combination of PCA, rank-ordering item-total correlation and communality, as well as clinical consensus further reduced the questionnaire to 10 items. Internal consistency of the CSI was 0.97. Test-retest reliability was r = 0.83. An r = 0.60 for divergent validity between the CSI and the Cough-Specific Quality-of-Life Questionnaire (CQLQ) demonstrated two fairly separate instruments, although both measured cough. Mann-Whitney test was significant between symptomatic patients and healthy controls (P < 0.0004). The results of 20 HC showed a mean of 0.45 (standard deviation = 1.39). Results for treatment outcomes revealed significance with the Wilcoxon test (P < 0.0001) and paired samples t test showed significantly different correlations between pre- and postmeasures. The CSI is a short, simple instrument that can be used in the clinical setting to quantify a patient's symptoms of chronic cough of upper airway origin. It represents a statistically reliable, valid, and clinically relevant instrument that can be used to measure treatment outcomes for chronic cough.

Accuracy of cough reporting by carers of Indigenous children

The study aims to determine the reliability of a 24-h history of reported cough presence and quality (wet/dry) compared with objectively recorded cough, and evaluate factors that may influence cough reporting. A digital recorder (ICD-PX720, Sony, Tokyo, Japan) was attached to 47 Indigenous children for 24 h during admission at Royal Darwin Hospital. After recording, carers reported their child's cough details. Cough counts were objectively measured and details of cough reports by carer (cough present/absent, quality wet/dry, cough severity determined by visual analogue scale and verbal category descriptive score) were the main outcomes measured. Other factors examined were: carer's sex, age, education, smoking, carer's cough, parent versus non-parent, respiratory illness in child and mean parent-proxy cough-specific quality of life questionnaire. Data were entered into STATA (V.10, STATA Corp., College Station, TX, USA). Cohen's kappa (κ) coefficients and Spearman's rank correlation coefficient (rs ) were used for data analysis. Reporting of cough by Indigenous carers (compared with cough monitoring) was slight when a low cough threshold (0.25 coughs/h) was used (κ = 0.17, 95% CI -0.15, 0.49) and moderate when a higher cough threshold was used (κ = 0.57, 95% CI 0.28, 0.88). Carers' evaluation of wet cough disagreed with clinician's evaluation (κ = -0.24, 95% CI -0.58, 0.09). Subjective reporting of cough severity moderately correlated with objective cough rates (rs = 0.41 to 0.44, 95% CI 0.11, 0.67). None of the factors examined was associated with reliability of cough reporting. The unreliability of reporting of cough highlights the need for community education on the importance of cough to improve health-seeking behaviour for early detection and treatment of respiratory disease.

Parent cough-specific quality of life: Development and validation of a short form

Cough is a distressing symptom and has a significant effect on many children and their families. Quality-of-life (QOL) measures provide important outcome indicators for clinicians and aid in evaluating the efficacy of interventions. The aim of this study was to develop and validate a short cough-specific QOL questionnaire for pediatric use. Two sources provided data to establish a shortened version of the Parent Cough-specific Quality of Life (PC-QOL) questionnaire. The first (n=240, 137 boys; median age, 29 months [interquartile range, 14-64 months]) was used for development and cross-validation. Stepwise regression was used to select the reduced set of items, and analyses of reliability, validity, and minimally important differences determined psychometric strength and sensitivity to change. The second independent dataset (n=320, 190 boys; median age, 39.5 months [interquartile range, 16-77 months]) was used as a confirmatory sample. Forward-step regression identified 8 items that accounted for 95% of the variance in the full-scale PC-QOL questionnaire. This shortened version (PC-QOL-8) was internally consistent (Cronbach α=0.84), had good test-retest reliability (intraclass correlation coefficient=0.66), and demonstrated strong validity (significant correlations with a cough verbal category descriptor score, cough visual analog scale, and subscales of the Short Form-12 General Health scale, the Pediatric Quality of Life Inventory, and the Depression, Anxiety, and Stress Scale). The reduced scale was responsive to change, and a minimally important difference of 0.9 was suggested. These findings were confirmed with the second dataset. The PC-QOL-8 questionnaire is a short, reliable, and valid instrument for assessing the effect of a child's chronic cough. It demonstrated sensitivity to change, and its length and psychometric properties should enhance its potential uptake and routine use in clinical practice and research.

Randomised clinical trial: high-dose acid suppression for chronic cough - a double-blind, placebo-controlled study

Cough may be a manifestation of gastro-oesophageal reflux disease (GERD). The utility of acid suppression in GERD-related cough is uncertain. To assess the impact of high-dose acid suppression with proton pump inhibitors (PPI) on chronic cough in subjects with rare or no heartburn. Subjects were nonsmokers without history of asthma, with chronic cough for >8 weeks. All subjects underwent a baseline 24-h pH/impedance study, methacholine challenge test and laryngoscopy. Subjects were randomised to either 40 mg of esomeprazole twice daily or placebo for 12 weeks. The primary outcome measure was the Cough-Specific Quality of Life Questionnaire (CQLQ). Secondary outcomes were response on Fisman Cough Severity/Frequency scores and change in laryngeal findings. Forty subjects were randomised (22 PPI, 18 placebo) and completed the study. There was no difference between PPI and placebo in CQLQ (mean improvement 9.8 vs. 5.9 respectively, P = 0.3), or Fisman Cough Severity/Frequency scores. Proportion of patients who improved by >1 s.d. on the CQLQ was 27.8% (five of 18) and 31.8% (seven of 22) in the placebo and PPI groups respectively. In subjects with chronic cough and rare or no heartburn, high-dose proton pump inhibitor does not improve cough-related quality of life or symptoms.