TY - JOUR
T1 - Patient Global Impression of Severity Scale in Chronic Cough
T2 - Validation and Formulation of Symptom Severity Categories
AU - Rhatigan, Katherine
AU - Hirons, Barnaby
AU - Kesavan, Harini
AU - Turner, Richard D.
AU - Ebelthite, Candice
AU - Hull, James H.
AU - Jolley, Caroline J.
AU - Birring, Surinder S.
AU - Cho, Peter S.P.
N1 - Funding Information:
We thank all the patients for their participations in the study. We would like to thank the Chest Unit and the staff of the cough clinic at King's College Hospital for their assistance in characterizing the patients. We would also like to thank the IMPARTS team and Mitan Sudra for their assistance with data collection. P. S. P. Cho, S. S. Birring, and K. Rhatigan conceptualized and designed the study; K. Rhatigan, H. Kesavan, and C. Ebelthite collected the data; K. Rhatigan, P. S. P. Cho, and S. S. Birring analyzed the data; K. Rhatigan, P. S. P. Cho, S. S. Birring, and R. D. Turner interpreted the data and drafted the manuscript; K. Rhatigan, P. S. P. Cho, S. S. Birring, R. D. Turner, J. H. Hull, C. J. Jolley, C. Ebelthite, B. Hirons, and H. Kesavan revised the manuscript.
Funding Information:
Conflicts of interest: P. S. P. Cho has received an EPSRC grant outside of this work and a Merck Investigator Studies Programme grant outside of this work. S. S. Birring has received personal fees for consultancy from Merck, Bellus, Trevi, Genentech, Nerre, Kinevant, Boehringer Ingelheim, and Bayer. J. H. Hull has received advisory fees from MSD Pharmaceuticals and medical advisory board work for Bellus Health. The rest of the authors declare that they have no relevant conflicts of interest.
Publisher Copyright:
© 2023 The Authors
PY - 2023/12
Y1 - 2023/12
N2 - Background: The Patient Global Impression of Severity (PGI-S) scale is a self-reported, single-item categorical scale that is increasingly used when assessing chronic cough (CC). Objective: This study aimed to establish validity, repeatability, and responsiveness of the PGI-S scale in CC and use the scale to define discrete categories of severity when measured with other commonly used patient-reported outcome (PRO) tools. Methods: Consecutive patients with CC completed the PGI-S scale, cough severity and urge to cough visual analog scales (VAS), and cough-specific health status Leicester Cough Questionnaire (LCQ) at a clinic visit. Validity, repeatability, and responsiveness were assessed, and threshold scores for PRO severity categories determined. Results: A total of 482 participants completed the assessments; the median (interquartile range [IQR]) age was 57 (46-67) years, 71% were female, and the median (IQR) duration of cough was 48 (24-120) months. They reported a median (IQR) PGI-S score of 3 (3-4; moderate severity), cough severity VAS of 57 (31-75) mm, urge to cough VAS of 62 (40-81) mm, and LCQ of 11.5 (8.7-14.4). There were strong associations between PGI-S scores and cough severity VAS (ρ = 0.81), urge to cough VAS (ρ = 0.73), and LCQ (ρ = −0.73) (all P <.001). Repeatability of the PGI-S scale was high (n = 77); the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.77-0.91) (P <.001). The PGI-S scale was responsive in participants with a treatment response (P <.001). The suggested PRO thresholds to define severe cough are ≥61 mm (cough severity VAS), ≥71 mm (urge to cough VAS), and ≤10 (LCQ). Conclusion: The PGI-S scale is a simple and valid tool that characterizes cough severity and is repeatable and responsive in CC. The proposed categorical severity thresholds for VAS and LCQ can provide intuitive meaning for patients and clinicians.
AB - Background: The Patient Global Impression of Severity (PGI-S) scale is a self-reported, single-item categorical scale that is increasingly used when assessing chronic cough (CC). Objective: This study aimed to establish validity, repeatability, and responsiveness of the PGI-S scale in CC and use the scale to define discrete categories of severity when measured with other commonly used patient-reported outcome (PRO) tools. Methods: Consecutive patients with CC completed the PGI-S scale, cough severity and urge to cough visual analog scales (VAS), and cough-specific health status Leicester Cough Questionnaire (LCQ) at a clinic visit. Validity, repeatability, and responsiveness were assessed, and threshold scores for PRO severity categories determined. Results: A total of 482 participants completed the assessments; the median (interquartile range [IQR]) age was 57 (46-67) years, 71% were female, and the median (IQR) duration of cough was 48 (24-120) months. They reported a median (IQR) PGI-S score of 3 (3-4; moderate severity), cough severity VAS of 57 (31-75) mm, urge to cough VAS of 62 (40-81) mm, and LCQ of 11.5 (8.7-14.4). There were strong associations between PGI-S scores and cough severity VAS (ρ = 0.81), urge to cough VAS (ρ = 0.73), and LCQ (ρ = −0.73) (all P <.001). Repeatability of the PGI-S scale was high (n = 77); the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.77-0.91) (P <.001). The PGI-S scale was responsive in participants with a treatment response (P <.001). The suggested PRO thresholds to define severe cough are ≥61 mm (cough severity VAS), ≥71 mm (urge to cough VAS), and ≤10 (LCQ). Conclusion: The PGI-S scale is a simple and valid tool that characterizes cough severity and is repeatable and responsive in CC. The proposed categorical severity thresholds for VAS and LCQ can provide intuitive meaning for patients and clinicians.
KW - Assessment
KW - Cough
KW - Severity
KW - Thresholds
UR - https://www.scopus.com/pages/publications/85172028366
U2 - 10.1016/j.jaip.2023.08.046
DO - 10.1016/j.jaip.2023.08.046
M3 - Article
C2 - 37678666
AN - SCOPUS:85172028366
SN - 2213-2198
VL - 11
SP - 3706-3712.e1
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 12
ER -