Domains and items related to measurement of cough severity in adult patients with chronic cough
| Domain, n | Subdomain, n | Item, n | Example phrases |
| Urge-to-cough (n=31): sensations (i.e. laryngeal, chest) that can lead to cough | “Although technically not a “cough” as defined medically, patients considered this sensation (urge) an inseparable part of the cough experience indicating it should be a component of an evaluation tool.” | ||
| Urge frequency (n=5) | Urge frequency (n=5) | “The most common descriptions were abnormal sensation in the throat, phlegm and mucus in the throat, tickle and irritation in the throat and a tickle in the throat. The median response for abnormal sensation, phlegm and irritation was 3.0 [on a scale of 1=all of the time to 7=none of the time] which indicates that the majority of patients rated that item occurring at least a good bit of the time.” “There was infrequent occurrence of pushing on the chest, pressing on the throat, food catching, itch and tingle. The majority of these participants rated these items between 4.0 and 7.0 ranging from some of the time to none of the time.” “How much warning do you get before you cough? 1=None, 2=Occasionally, 3=Frequently” “Meanwhile, a study of urge to cough and associated somatic sensations in 100 unselected patients with chronic cough attending a specialist clinic in UK found that 91% always cough in response to urge to cough and that the urge to cough was frequently associated with abnormal throat sensations such as irritation (86%) and tickling (73%).” | |
| Urge intensity (n=6) | Urge intensity (n=6) | “Sometimes I can't sleep at all night. I have to get up and go get in a chair, because whatever is coming out of my head or my throat is sitting in this bronchial tube down there, and it's messing up everything.” “In the last 2 weeks…I have been annoyed by an irritation, such as a tickle or itch in my throat.” “Well I think the more you try and like think ‘Don't let the tickle … don't let the tickle bother you and don't cough’, sometimes the tickle comes like to a point where you just can't stop it.” “People with chronic cough may cough deliberately in response to a sensation in the throat even though referred for behavioural management of cough. The issue, in these cases, is the perception of a throat sensation rather than the actual cough.” “And that then trickles down here, and then I cough like the devil… I get-it sticks here, great big chunks of it will stick here-can't get it out.” “Congestion in throat (as though something “fuzzy” there that needs to be swallowed) and chest. Need to clear throat to get rid of it.” | |
| Cough (n=58) | Cough control (n=10) | Cough control to prevent a cough from starting (n=3) | “People with chronic cough may cough deliberately in response to a sensation in the throat even though referred for behavioural management of cough.” “It is hypothesised that warning before the cough characterised by irritation in the throat or a strangulating sensation is an important precursor to controlling the cough and that if people can anticipate that a cough is about to occur they can be taught strategies to inhibit the cough before it starts.” “Do you cough deliberately to clear something from your throat? 1=None, 2=Occasionally, 3=Frequently” |
| Cough control once a cough has started (n=3) | “The majority of respondents (63%) were unable to suppress their cough.” “The final cough was absolutely – absolutely retched and, ugh, I think was XXXXX who mentioned embarrassed. Ugh, I had a lot of – I had a number of meetings that I – that I had to go to and, uh, I couldn't stop coughing in those things.” “An uncontrolled cough is very unpleasant for the patient.” “The cough controlled me, I had no control at all over when I coughed, how often I coughed, how strong the cough was … it got to the point where … I didn't even want to go out to get my shopping.” | ||
| Cough frequency (n=33) | Overall frequency, defined as frequency of single coughs and fits/bouts (n=28) | “How often does the current cough bother you? 1. Every day more than once a day, 2. Every day at least once a day, 3. Four to six days a week, 4. Two to three days a week, 5. At least once a week, 6. Less than once a week.” “The cough controlled me, I had no control at all over when I coughed, how often I coughed.” “I'm not coughing at all and, you know, it could be months before I get another cough, but when I get a cough, the frequency is close to ten and how bad it is can be a ten.” “Which of the following best describes the pattern of coughing? 1=cough occurs in bouts, 2=cough occurs continuously throughout the day, 3=other (please specify)” | |
| Daytime frequency (n=14) | “Counting the recordings in hourly segments allowed for a diurnal cough profile to be produced and this has been presented as three diurnal phases (figure 2). The mean cough scores for the nocturnal phase was significantly lower (p<0.001) than the daytime or early evening phases.” “Numerical Cough Scoring System Day: 0=no cough during the day, 1=cough for one short period, 2=cough for >two short periods, 3=frequent coughing that did not interfere with usual daytime activities, 4=frequent coughing that did interfere with usual daytime activities, 5=distressing cough most of the day.” | ||
| Night-time frequency (n=21) | “Counting the recordings in hourly segments allowed for a diurnal cough profile to be produced and this has been presented as three diurnal phases. The mean cough scores for the nocturnal phase was significantly lower (p<0.001) than the daytime or early evening phases.” “For me it's not being able to sleep, you know, just waking up coughing, coughing, and coughing.” “…I cough a lot when I go to bed. I lay down, and I find that makes me cough a lot.” “Has the cough disturbed your sleep in the previous 2 weeks? All the time, most of the time, part of the time, a small part of the time, almost never, never.” “A cluster of factors developed as the most indicative for estimating the practical and emotional impact that chronic cough has on patients’ quality of life and included: high cough frequency, presence (and frequency) of nocturnal coughing, …” “Uh, yes, uh, I wake up at least by midnight and have a series of coughs and then about 3:00.” “Numerical Cough Scoring System Night: 0=no cough during the night, 1=cough on waking only, 2=wake once or early because of cough, 3=frequent waking because of cough, 4=frequent cough most of the night, 5=distressing cough most of the night.” | ||
| Morning frequency (n=6) | “Cough symptoms: how much did you cough in the morning? (in the past 7 days, range from never to always)” “Some of the participants reported that they experience more frequent coughing in the morning…” | ||
| Prandial/postprandial frequency (n=8) | “I cough after I drink or eat.” “Cough on eating Percentage of patients with the symptom: 74.4” | ||
| Fit/bout frequency (n=12) | “Cough bout frequency (median, range) Participants without repetitive doctor's consultations due to cough, n=840: daily (less than weekly to several times a day) Participants with repetitive doctor's consultations due to cough, n=135: several times a day (less than weekly to several times a day) p value: <0.001” “In the last 2 weeks…I have had coughing bouts.” “In the last 2 weeks, how many times a day have you had coughing bouts? 1=all the time (continuously), 2=most times during the day, 3=several times during the day, 4=some times during the day, 5=occasionally through the day, 6=rarely, 7=none.” | ||
| Fit/bout duration (n=4) | Fit/bout duration (n=4) | “Paroxysms of coughing, which were extended bouts of individual coughs and that were described as less controllable than a single cough, were also a component of frequency.” “Quantification in terms of epochs (frequency) effectively ignored epoch length; the poorer correlations with cough quality of life and VAS imply that epoch length was important to patients.” | |
| Intensity (n=17) | “Patients’ perceptions of the severity of their cough remain important and may not correlate [with cough frequency] for a number of reasons, including changes in cough intensity.” | ||
| Effort to cough (n=6) | “It sticks here, great big chunks of it will stick here-can't get it out. And I cough, and cough, and cough, and then if you go to a restaurant and start coughing, they throw you out.” “Difficulty to expectorate.” “Sputum symptoms: how difficult was it for you to bring up phlegm? (in the past 7 days, ranging from “not at all” to “a lot/extremely”)” “In the last 2 weeks…I have found it difficult to cough up phlegm (sputum)” “This physical effort [of coughing] was associated with a range of [adverse] symptoms.” “Patients described the physicality of the cough and described the sheer effort a ‘fit’ took.” | ||
| Harshness of cough (n=2) | “Intensity of coughing was described in terms of how ‘deep,’ ‘hard,’ or ‘harsh,’ the coughing was.” | ||
| Deepness of cough (n=2) | “…it was a really deep hacking, not just an ordinary sort of cough, very deep, you know, from your chest.” | ||
| Hacking due to cough (n=2) | “Mine is very hacking, and it's not intense or deep, and nothing comes up. It's not productive…. It's dry hacking.” | ||
| Barking due to cough (n=1) | “Character of cough: Barking - having a sound quality similar to that of a dog's bark.” | ||
| Honking due to cough (n=1) | “Character of cough: Honking - sounding like the honk of a Canadian wild goose.” | ||
| Strong cough (n=2) | “I had no control at all over when I coughed, how often I coughed, how strong the cough was.” | ||
| Intense cough (n=1) | “Mine is very hacking, and it's not intense or deep.” “I have it under control with the medication, but I still get some fits that usually last five minutes, and they're rather intense, uh, in coughing.” | ||
| Experiences while coughing that are associated with intensity | |||
| Associated features/sequelae (n=44) | Dizziness due to cough (n=4) | “To me that strikes me as always a very serious bout of coughing, because obviously, oxygen wasn't getting where it was supposed to be getting. Um, and I find this is freaky, especially if you're driving, you know, and your coughing, and all of a sudden you're dizzy.” | |
| Syncope due to cough (n=6) | “I feel I may pass out because of my coughing.” | ||
| Wheeze due to cough (n=13) | “Cough was commonly associated with other symptoms such as […] wheeze (37%)…” | ||
| Dyspnoea/shortness of breath due to cough (n=15) | “Cough was commonly associated with other symptoms such as breathlessness (55%)…” “This physical effort was associated with a range of symptoms […]: It’s retching, it's struggling for breath […] It's like sometimes it's working its way up to a crescendo until I am sick.” | ||
| Incontinence due to cough (n=15) | “In addition, cough resulted in disturbed sleep in 70%, sore throat in 45% and caused incontinence in 55% of women and 5% of men.” “Incontinence No problem: 77 (57% of chronic cough patients) Small problem: 41 (30% of chronic cough patients) Major problem: 18 (13% of chronic cough patients)” “In the last 2 weeks…I have been incontinent of urine (wet my underwear) during coughing.” “Sometimes I wet on myself I cough so hard and it makes my head hurt.” “[He] coughed so hard that […] now, I have incontinence [sic] so bad, that I have to urinate every hour.” “[Cough] was the most important symptom in 31% of patients and up to 36% had reached the stage of retching, vomiting or being incontinent during cough episodes.” | ||
| Tightness of throat due to cough (n=4) | “I feel tightness in my throat when I am having a coughing problem.” | ||
| Tightness of chest due to cough (n=5) | “Within the last month, how did the following problems affect you? (0=no problem and 5=severe/frequent problem) Chest tightness when coughing” | ||
| Distress due to cough (n=3) | “Finally, several studies reviewed included measures that assessed intensity of cough (e.g. distressing cough; chest/abdominal pain).” | ||
| Immediate experiences after coughing that are associated with intensity depending on susceptibility | |||
| General pain due to cough (n=6) Rib pain or fracture due to cough (n=6) Chest pain due to cough (n=13) Abdominal pain due to cough (n=6) Back pain due to cough (n=2) | “I've gotten to that point where I'm coughing, I mean, the diaphragm, the rib cage, umm, is painful.” “Have you had chest or stomach pain due to cough in the last 2 weeks? All the time, most of the time, part of the time, a small part of the time, almost never, never.” “What are the following symptoms or ailments have you had in the last month? Chest pain during exertion, […] back pain, …” “Broken ribs, retching, chest pains, or hoarseness No problem: 64 (47% of chronic cough patients) Small problem: 47 (35% of chronic cough patients) Major problem: 25 (18% of chronic cough patients)” “In the last 2 weeks…I have had chest pain during coughing.” “[He] coughed so hard that I have developed costacondritis [sic] (cracked rib cartilage) twice and ended up in the emergency room, adding that now, I have incontinence [sic] so bad, that I have to urinate every hour.” “Last year the cough was so severe I fractured two ribs.” “I am at my wits end,” adding “my ribs and my back are very sore from all the coughing.” | ||
| Aches due to cough (n=1) | “Spectrum and frequency of adverse occurrences before and after treatment in patients whose cough was eliminated Achiness: before treatment (%): 21; after treatment (%): 0” | ||
| Headache due to cough (n=8) | “Have you had stomach pain or headache as a result of cough? (not at all to extremely)” “Sometimes I throw up a lot of mucus and I really cough a lot at night…Sometimes I wet on myself I cough so hard and it makes my head hurt.” “However transient, severe headache upon coughing […] is defined as “cough headache”. Cough headache [is] considered to be a form of exertional headache.” | ||
| Sore throat due to cough (n=3) | “In addition, cough resulted in […] sore throat in 45% [of patients].” “…I keep coughing, and that's when your throat starts to hurt.” | ||
| Tiredness/exhaustion due to cough effort (n=15) | “Cough was commonly associated with other symptoms such as feeling tired or drained (72%)…” “Do you feel drained or tired due to your cough? Never, seldom, sometimes, often, always, NA” “… one of those (coughs) that goes on and on and on and I think ‘I can't do with that, it's tired me out’ … you know drained.” | ||
| Voice change/hoarseness due to cough (n=15) | “I had one on a job interview, and by the time I was done trying to speak, I sounded like Minnie Mouse on speed. I was so squeaky. But it (the cough) wouldn't stop, just would not stop.” “In the last 2 weeks, have you suffered from hoarseness due to coughing? All the time, most of the time, part of the time, a small part of the time, almost never, never.” “My coughing problem affects my voice” “I am often hoarse because of my cough.” “In the last 2 weeks, have you suffered from hoarseness due to coughing? 1. All the time, 2. Most of the time, 3. Most of the time, 4. Part of the time, 5. A small part of the time, 6. Almost never, 7. Never.” | ||
| Retching/vomiting due to cough (n=12) | “I will cough, and cough, and cough, and cough until I basically have triggered, you know, trying to vomit in my stomach kind of thing.” “Intense coughing sometimes had broader physical effects including pain, discomfort, and vomiting.” “…the minute he gets up he coughs until he vomits many times.” “[Cough] was the most important symptom in 31% of patients and up to 36% had reached the stage of retching, vomiting or being incontinent during cough episodes.” | ||
| Expectoration of phlegm, sputum, or mucus (n=19) | “I stopped going to church because people look at me like I have something really bad. Sometimes I throw up a lot of mucus…” “During the previous 2 weeks, have you been disturbed by the increase in sputum during coughing? 1. Every time, 2. Most often, 3. Often, 4. Sometimes, 5. From time to time, 6. Rarely, 7. Never.” | ||
| Umbilical hernia due to cough (n=1) | “Other cough complications were encountered in 25 patients. These were […] umbilical hernia (6 patients, 3.6%)…” | ||
| Excessive sweating due to cough (n=1) | “Spectrum and frequency of adverse occurrences before and after treatment in patients whose cough was eliminated Excessive sweating: before treatment (%): 29; after treatment (%): 7” | ||
| Watery eyes due to cough (n=1) | “This physical effort [of coughing] was associated with a range of symptoms including headache, eyes watering, pain, syncope and incontinence.” | ||
| Runny nose due to cough (n=1) | “It's retching, it's struggling for breath … it's vomiting … Nose running, headaches with just the coughing.” | ||
Data presented as n, i.e. number of studies endorsing the item or domain. NA: not applicable.