title: Tools for assessing outcomes in studies of chronic cough: CHEST guideline and expert panel report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada. Electronic address: lpboulet@med.ulaval.ca.
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
authors.affiliation: Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Remy R
authors.initials: RR
authors.lastname: Coeytaux
authors.affiliation: Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: McCrory
authors.affiliation: Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: French
authors.affiliation: Department of Respiratory Medicine, Royal Children's Hospital, Herston, QLD, Australia.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, London, England.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Birring
authors.affiliation: University Hospital of South Manchester, Manchester, England.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Smith
authors.affiliation: American College of Chest Physicians, Glenview, IL.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Diekemper
authors.affiliation: Virginia Commonwealth University, Richmond, VA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Rubin
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Irwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000996:Antitussive Agents / Q000627:therapeutic use; D035843:Biomedical Research; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010506:Periodicals as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D000996:Antitussive Agents