Boulet Louis-Philippe, Coeytaux Remy R, McCrory Douglas C, French Cynthia T, Chang Anne B, Birring Surinder S, Smith Jaclyn, Diekemper Rebecca L, Rubin Bruce, Irwin Richard S
Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada.
Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.
Chest. 2015 Mar;147(3):804-814. doi: 10.1378/chest.14-2506.
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.
自2006年美国胸科医师学会（CHEST）咳嗽指南发布以来，已开发或进一步完善了多种用于评估咳嗽的工具。本委员会的目的是评估从事慢性咳嗽临床研究的调查人员所使用的工具。具体目标是：（1）评估旨在测量慢性咳嗽成人、青少年和儿童咳嗽频率、严重程度及影响的工具的性能；（2）根据这些发现提出建议。
按照CHEST方法学指南，CHEST咳嗽专家小组的建议基于美国医疗保健研究与质量局委托进行的一项最近发表的比较有效性综述、发表在CHEST上的相应总结以及截至2013年11月的更新系统综述。基于这些数据的建议在咳嗽专家小组会议上进行了讨论、分级和投票。
对于抱怨慢性咳嗽的成人、青少年（≥14岁）和儿童，我们建议使用经过验证且可靠的健康相关生活质量（QoL）问卷作为评估咳嗽影响的首选测量方法，例如成人和青少年患者使用莱斯特咳嗽问卷和咳嗽特异性生活质量问卷，儿童使用家长咳嗽特异性生活质量问卷。我们建议使用声学咳嗽计数来评估咳嗽频率，但不用于评估咳嗽严重程度。关于视觉模拟量表、数字评定量表和诱咳激发试验的性能，现有数据有限。
建议使用经过验证且可靠的咳嗽特异性健康相关QoL问卷作为评估咳嗽对患者影响的首选测量方法。它们之间的比较情况尚待确定。使用视觉模拟或数字评定量表报告咳嗽严重程度时应进行标准化。除非新版本已被证明可靠有效，否则不应修改先前经过验证的QoL问卷或其他咳嗽评估方法。最后，在研究环境中，诱咳激发试验在理解咳嗽机制方面发挥作用。
