Cough as an Endpoint in IPF: Why it Matters

Read the Blog
Strados Labs logo

Leicester Cough Questionnaire: An Overview

by | Jun 10, 2024 | Blog, Blog - Clinical Trial Focus

The Leicester Cough Questionnaire (LCQ)1 is a self-reporting tool developed by S.S. Birring and others to evaluate the impact of chronic cough on a patient’s quality of life.

Chronic cough,2 which impacts between 10-20% of the US population,3 is a cough that can last up to 8 weeks or longer. It can be both a symptom of another health condition such as Idiopathic pulmonary fibrosis (IPF)4 or asthma5 or a disease without an underlying cause. More than an annoyance, chronic cough can severely harm quality of life, including interrupting sleep, disrupting social life and much more; hence, having a way to assess the impact of chronic cough is critical.

What is the Leicester Cough Questionnaire?

The Leicester Cough Questionnaire is a self-administered health-related quality of life questionnaire6 that is used to assess the severity of chronic cough. It contains 19 items with a 7 point Likert response scale (range 1 to 7), that is split into three domains: 

  • Physical: Evaluates the physical symptoms and limitations that patients experience due to their chronic cough
  • Psychological: Assesses the emotional and mental burden caused by a chronic cough
  • Social: Measures social disruptions and consequences such as personal relationships and emotional reactions due to chronic cough

Patients are asked 19 questions analyzing their cough over the previous two weeks, which include the areas of; sputum, stomach or chest pain, anxiety, energy levels, sleep disturbances, and embarrassment. The total severity score ranges from 3 to 21,6 with a low score indicating worse cough and quality of life. 

Why Use the Leicester Cough Questionnaire?

Studies have shown that the Leicester Cough Questionnaire (LCQ) is reliable, valid, and responsive7 in measuring the impact of chronic cough in adolescents and adults. Furthermore, the LCQ has been validated in cystic fibrosis, COPD, acute cough and bronchiectasis where chronic cough is common, as well as being validated for use in multiple languages. 

Clinicians and researchers can use the LCQ to assess the severity of patients’ chronic cough in multiple settings:

  • Clinical Practice:  Measuring and assessing the disease burden in patients with chronic cough can help clinicians provide better care.
  • Public Health Research: Supports epidemiological studies aiming to understand the prevalence, causes, and impact of chronic cough across the general population.
  • Drug Development: Offers a way to measure the effectiveness of new therapies and treatments designed to relieve chronic cough symptoms.

Additionally, the LCQ can also be used alongside objective cough monitoring technologies such as the RESP®  Biosensor. Using a combination of objective monitoring and questionnaires like the LCQ provides the most complete insight into patients’ cough. 

Questions

Each question or item on the Leicester Cough Questionnaire assesses symptoms or the impact of symptoms on the patient’s quality of life over the past two weeks, using a scale ranging from7 all of the time to none of the time. Here are some sample questions from the LCQ8:

Physical Domain

  • How often did you experience coughing bouts that caused chest pain in the past two weeks?
  • Have you been bothered by phlegm production when you cough? 

Psychological Domain

  • My cough has interrupted my job or other daily tasks
  • Have you felt embarrassed by your coughing? 

Social Domain

  • I feel that my cough has annoyed my family, partner, or friends
  • My cough has interrupted telephone calls or conversations

Click here for the full questionnaire and PDF of the Leicester Cough Questionnaire

Anchoring the LCQ with Objective Cough Monitoring

While the LCQ is a validated instrument for assessing cough,7 it is inherently subjective. Studies show9 that data from objective monitoring tools can show vastly different results compared to patient self-reports. 

In the 2021 DETECT Health Study conducted by Scripps Research, results showed that objective cough monitoring using the RESP® Biosensor didn’t match patient self-reporting in 75% of subjects. In particular, the RESP Biosensor detected the presence of coughs in all patients who subsequently developed respiratory symptoms despite initial self-reported absence of coughs by these patients.

A comparison of Self-Reported Cough Symptoms vs RESP Biosensor Cough Detections

  • Cough Detections DO NOT MATCH Self-Reported Coughing
  • Cough Detections MATCH Self-Reported Coughing
Cough Monitoring Device - RESP Biosensor
RESP Biosensor for Objective Cough Monitoring

Learn more about the RESP® Biosensor for research studies

Objective cough monitoring can provide quantitative measurements of patients’ cough in daily life to anchor patient self-reports. Common measurements include 24-hour cough frequency, the number of coughing bouts, and cough intensity levels. 

Further, cough monitoring is also limited in that it doesn’t offer the patient’s opinion or perspective. Therefore, a combination of questionnaires such as the LCQ and objective monitoring tools provide the most complete insight.

References:

  1. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MDL, Pavord ID. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-343. doi:https://doi.org/10.1136/thorax.58.4.339
  2. Alhajjaj MS, Bajaj P. Chronic Cough. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK430791/
  3. Chronic Cough: Causes & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/15048-chronic-cough-overview
  4. Mann J, Goh NSL, Holland AE, Khor YH. Cough in Idiopathic Pulmonary Fibrosis. Frontiers in Rehabilitation Sciences. 2021;2. doi:https://doi.org/10.3389/fresc.2021.751798
  5. ACAAI. Asthma Cough | Causes, Symptoms & Treatment. ACAAI Public Website. Published 2022. https://acaai.org/asthma/symptoms/asthma-cough/
  6. Murray MP, Turnbull K, MacQuarrie S, Pentland JL, Hill AT. Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis. European Respiratory Journal. 2009;34(1):125-131. doi:https://doi.org/10.1183/09031936.00160508
  7. Nguyen AM, Schelfhout J, Muccino D, et al. Leicester Cough Questionnaire validation and clinically important thresholds for change in refractory or unexplained chronic cough. Therapeutic Advances in Respiratory Disease. 2022;16:175346662210997. doi:https://doi.org/10.1177/17534666221099737
  8. Leicester Cough Questionnaire (LCQ). Accessed June 6, 2024. https://voicefit.co.uk/wp-content/uploads/sites/8/2021/04/Leicester-Cough-Questionnaire.pdf
  9. J Jakusova, M Brozmanova. Methods of Cough Assessment and Objectivization. Physiological Research. Published online January 1, 2023:687-700. doi:https://doi.org/10.33549/physiolres.935062