Leicester Cough Questionnaire Score Research Articles

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

Background: There are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis. Methods: Twenty patients with bronchiectasis (43.5 ± 14.1 years) and 20 healthy subjects (43.0 ± 10.9 years) participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP), and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC) were determined. A six-minute walk test (6MWT) was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively) using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS) and the Leicester Cough Questionnaire (LCQ), respectively. Results: Number of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p<0.05). In bronchiectasis patients, QMS was significantly associated with HGS, MIP and MEP (p<0.05). The 6MWT distance was significantly correlated to LCQ psychological score (p<0.05). The FSS score was significantly associated with LCQ physical and total and MMRC scores (p<0.05). The LCQ psychological score was significantly associated with MEP and 6MWT distance (p<0.05). Conclusions: Peripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

Evaluation of the chronic obstructive pulmonary disease assessment test for measurement of health‐related quality of life in patients with interstitial lung disease

A well-validated instrument that is simple to use is needed to assess health-related quality of life in patients with interstitial lung disease (ILD). The COPD assessment test (CAT) is a recently introduced, short and simple questionnaire for COPD patients, which shows good and valid measurement properties. This study was conducted to evaluate the validity of the CAT in patients with ILD. Patients with ILD (n = 55) completed the CAT and the St. George's Respiratory Questionnaire (SGRQ). These patients also completed the Medical Research Council (MRC) dyspnoea scale, the Leicester Cough Questionnaire (LCQ), and the hospital anxiety and depression scale; performed 6-min walk tests and pulmonary function tests; and provided samples for arterial blood gas analysis. There was a very strong correlation between the CAT score and the SGRQ total score (r = 0.93, P < 0.0001). The CAT score was also significantly correlated with the SGRQ symptoms score (r = 0.74, P < 0.0001), the SGRQ activity score (r = 0.87, P < 0.0001) and the SGRQ impact score (r = 0.89, P < 0.0001). Stepwise multiple regression analysis demonstrated that the MRC and LCQ scores contributed most to both the CAT score and the SGRQ total score. The CAT is a short and simple questionnaire that shows good and valid measurement properties for assessing the health status of patients with ILD.

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

BackgroundThere are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis.MethodsTwenty patients with bronchiectasis (43.5 ± 14.1 years) and 20 healthy subjects (43.0 ± 10.9 years) participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP), and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC) were determined. A six-minute walk test (6MWT) was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively) using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS) and the Leicester Cough Questionnaire (LCQ), respectively.ResultsNumber of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p < 0.05). In bronchiectasis patients, QMS was significantly associated with HGS, MIP and MEP (p < 0.05). The 6MWT distance was significantly correlated to LCQ psychological score (p < 0.05). The FSS score was significantly associated with LCQ physical and total and MMRC scores (p < 0.05). The LCQ psychological score was significantly associated with MEP and 6MWT distance (p < 0.05).ConclusionsPeripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

The values of fractional exhaled nitric oxide in the diagnosis and treatment of chronic cough

To evaluate the values of fractional exhaled nitric oxide (FENO) in the diagnosis and treatment of chronic cough. Based on the protocol from The Chinese Respiratory Society guidelines for management of cough, 75 consecutive subjects with chronic cough and normal chest radiographs were recruited from the outpatient clinic of the Department of Respiratory Diseases in China-Japan Friendship Hospital from January to June 2010. All the patients accepted FENO tests, sputum cell counts, pulmonary function tests, bronchial hyperresponsiveness (BHR), serum IgE, cough symptom scores and Leicester cough Questionnaire (LCQ) before and after treatment of 4 weeks. The final diagnosis of the subjects included 29 with cough variant asthma (CVA), 19 with eosinophilic bronchitis (EB) and 27 with other causes (Others). FENO levels in CVA (58 ± 26) ppb were significantly higher than those in EB (36 ± 18) ppb and Others (20 ± 7) ppb, and the FENO levels in EB were higher than Others (F = 28.2, P < 0.01). FENO levels showed significant correlations with sputum eosinophils, BHR, cough symptom scores, non-specific IgE, and LCQ scores. The mean baseline FENO level of the subjects whose coughs were relieved after inhaled corticosteroid therapy was (63 ± 42) ppb, higher than those of the non-responders (28 ± 13) ppb (t = 3.91, P < 0.01). There were significant correlations between the percentage of FENO decrease and the percentage of sputum eosinophil decrease or the cough symptom score decrease. FENO could be used as a inflammation marker of chronic cough because of its good correlation with sputum eosinophils, AHR, atopy, and cough symptoms. FENO also has a potential to predict the response of anti-inflammatory therapy because FENO decrease is correlated with the decrease of eosinophilic inflammation and improvement of cough symptoms.

A randomised crossover trial of chest physiotherapy in non-cystic fibrosis bronchiectasis

Regular chest physiotherapy is advocated in non-cystic fibrosis bronchiectasis despite little evidence supporting its routine use. This study aimed to establish the efficacy of regular chest physiotherapy in non-cystic fibrosis bronchiectasis compared with no regular chest physiotherapy. 20 patients not practising regular chest physiotherapy were enrolled in a randomised crossover trial of 3 months of twice daily chest physiotherapy using an oscillatory positive expiratory pressure device compared with 3 months of no chest physiotherapy. The primary end-point was the Leicester Cough Questionnaire (LCQ). Additional outcomes included 24-h sputum volume, forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), forced expiratory flow at 25-75% of FVC (FEF(25-75%)), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), exercise capacity, sputum microbiology and St George's Respiratory Questionnaire (SGRQ). The treatment effect was estimated using the differences of the pairs of observations from each patient. There was a significant improvement in all domains and total LCQ score with regular chest physiotherapy (median (interquartile range) total score improvement 1.3 (-0.17-3.25) units; p = 0.002). 24-h sputum volume increased significantly with regular chest physiotherapy (2 (0-6) mL; p = 0.02), as did exercise capacity (40 (15-80) m; p = 0.001) and SGRQ total score (7.77 (-0.99-14.5) unit improvement; p = 0.004). No significant differences were seen in sputum bacteriology, FEV(1), FVC, FEF(25-75%), MIP or MEP. Regular chest physiotherapy in non-cystic fibrosis bronchiectasis has small, but significant benefits.

Cough in adult cystic fibrosis: diagnosis and response to fundoplication

BackgroundGastroesophageal reflux is one of the most common causes of chronic cough in the general population. Reflux occurs frequently in patients with cystic fibrosis (CF). We undertook laparoscopic Nissen fundoplication in adult CF patients with a clinical diagnosis of reflux cough who had failed conventional medical therapies.ObjectiveWe determined the response to the surgical route in the treatment of intractable reflux cough in CF.MethodPatients with refractory cough were assessed by 24 h pH monitoring and oesophageal manometry. Pre-and post-operation cough, lung function and exacerbation frequency were compared. Cough was assessed by the Leicester Cough Questionnaire (LCQ), lung function by spirometry and exacerbation frequency was defined by comparing the postoperative epoch with a similar preoperatively.ResultsSignificant abnormalities of oesophageal function were seen in all patients studied. 6 patients (2 females), with the mean age of 34.5 years consented to surgery. Their mean number of reflux episodes was 144.4, mean DeMeester score was 39.2, and mean lower oesophageal sphincter pressure 12.4 mmHg. There was a small change in the FEV1 from 1.03 L to 1.17 (P = 0.04), and FVC improved from 2.62 to 2.87 (P = 0.05). Fundoplication lead to a marked fall in cough with the total LCQ score increasing from 11.9 to 18.3 (P = 0.01). Exacerbation events were reduced by 50% post operatively.ConclusionWhilst there is an obvious attention to respiratory causes of cough in CF, reflux is also a common cause. Fundoplication is highly effective in the control of reflux cough in CF. Significant reduction in exacerbation frequency may indicate that reflux with possible aspiration is a major unrecognised contributor to airway disease.

Airway clearance physiotherapy improves quality of life in people with bronchiectasis

Does regular airway clearance using an oscillating positive expiratory pressure (PEP) device improve quality of life, sputum volume, respiratory function, and exercise capacity in people with bronchiectasis? Randomised, crossover, controlled trial with 3-month intervention periods separated by a 1-month washout period. Acute teaching hospital in Scotland. 20 adults with radiologically diagnosed bronchiectasis and chronic sputum expectoration, who were not performing regular physiotherapy for airway clearance. Smoking, asthma, emphysema, and cystic fibrosis were exclusion criteria. While in the intervention arm, participants performed 20–30 minutes of airway clearance twice daily. Each session consisted of three cycles of 10 breaths through an oscillating positive expiratory pressure (PEP) device called the Acapella, followed by the forced expiratory technique and coughing. Each participant's technique was reviewed by a physiotherapist monthly during the intervention arm. During the control arm, the device was retained by the investigators and participants performed no physiotherapy for airway clearance. Throughout the study, both groups received all other standard management including antibiotics when exacerbation criteria were met. Any changes to the participants’ usual medication regimen were noted. The primary outcome was the Leicester Cough Questionnaire (LCQ) – a 19-point, patient-reported measure of the impact of cough severity on quality of life with three domains (physical, psychological, and social). Secondary outcomes included the St George's Respiratory Questionnaire (SGRQ), 24-hour sputum volume, lung function, maximum respiratory pressures, and the incremental shuttle walk test, measured at the end of each intervention arm. All participants completed the study with no adverse events during airway clearance. During the 3-month intervention period, the total LCQ score showed significantly greater improvement than during the control period: difference in medians for total LCQ score 1.3 points, p = 0.002. Each of the three domains within the LCQ also showed significant benefits. Other outcomes that showed significantly greater improvements due to the airway clearance intervention were the SGRQ (difference in medians 8.5 points, p = 0.005), 24-hr sputum volume (difference in medians 3 ml, p = 0.02), and the incremental shuttle walk distance (difference in medians 40 m, p = 0.001). The groups did not differ significantly on the remaining secondary outcomes. Regular airway clearance with oscillating PEP improves diseaserelated quality of life and exercise capacity in people with bronchiectasis.

Impact of Cough Across Different Chronic Respiratory Diseases: Comparison of Two Cough-Specific Health-Related Quality of Life Questionnaires

Cough is a prominent symptom across a range of common chronic respiratory diseases and impacts considerably on patient health status. We undertook a cross-sectional comparison of scores from two cough-specific health-related quality of life (HRQoL) questionnaires, the Leicester Cough Questionnaire (LCQ), and the Cough Quality of Life Questionnaire (CQLQ), together with a generic HRQoL measure, the EuroQol. Questionnaires were administered to and spirometry performed on 147 outpatients with chronic cough (n = 83), COPD (n = 18), asthma (n = 20), and bronchiectasis (n = 26). There was no significant difference in the LCQ and CQLQ total scores between groups (p = 0.24 and p = 0.26, respectively). Exploratory analyses of questionnaire subdomains revealed differences in psychosocial issues and functional impairment between the four groups (p = 0.01 and p = 0.05, respectively). CQLQ scores indicated that chronic coughers have more psychosocial issues than patients with bronchiectasis (p = 0.03) but less functional impairment than COPD patients (p = 0.04). There was a significant difference in generic health status across the four disease groups (p = 0.04), with poorest health status in COPD patients. A significant inverse correlation was observed between CQLQ and LCQ in each disease group (chronic cough r = - 0.56, p < 0.001; COPD r = - 0.49, p = 0.04; asthma r = - 0.94, p < 0.001; and bronchiectasis r = - 0.88, p < 0.001). There was no correlation between cough questionnaire scores and FEV(1) in any group, although a significant correlation between EuroQol visual analog scale component and FEV(1) (r = 0.639, p = 0.004) was observed in COPD patients. Cough adversely affects health status across a range of common respiratory diseases. The LCQ and CQLQ can each provide important additional information concerning the impact of cough.

How to quantify coughing: correlations with quality of life in chronic cough

Different methods are used for quantifying coughing in sound recordings, but as yet no method has been shown to be more valid than any other. In the present study, the relationships between three different units of cough were examined and their ability to predict subjective ratings of cough and cough-related quality of life were evaluated. In total, 70 subjects (mean+/-SD age 55+/-11.7 yrs, 51 (73%) females) with chronic unexplained cough (median duration 4.8 yrs, interquartile range 2.5-10.1 yrs) performed fully ambulatory 24-h sound recordings, which were manually counted by trained observers and quantified by 1) explosive phases, 2) cough seconds and 3) cough epochs. Subjects also completed cough visual analogue scales (VAS) and the Leicester Cough Questionnaire (LCQ). All units of cough were strongly correlated; explosive phases and cough seconds correlated slightly more strongly than cough seconds with cough epochs or explosive phases with cough epochs. LCQ scores correlated moderately with explosive phases and seconds; epochs correlated slightly less well. Cough VAS scores showed a similar pattern. Explosive phases and seconds are interchangeable units of cough, moderately related to subjective measures and cough-related quality of life; epochs are a less satisfactory alternative.

MINIMAL CLINICALLY IMPORTANT DIFFERENCE (MCID) OF THE DUTCH VERSION OF THE LEICESTER COUGH QUESTIONNAIRE AND BASELINE PREDICTORS OF REACHING THE MCID AFTER SIX MONTHS

PURPOSE: The Leicester Cough Questionnaire (LCQ)is used to determine health status in patients with chronic cough. Recently, the Dutch language version of the LCQ has been validated. The next step is to determine what change in LCQ scores is significant (i.e. what is the minimal clinically important difference (MCID)). This study aimed to identify the MCID of the LCQ after 6 months in terms of patient referencing. Moreover, we were interested which baseline factors were predictive of reaching the MCID after six months.