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Rehab Measures Database

Leicester Cough Questionnaire

Last Updated

Purpose

A 19 item, self-reported questionnaire assessing chronic cough and its impact on quality of life for patients with chronic respiratory disease. 

Link to Instrument

Link to instrument

Acronym LCQ

Area of Assessment

Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE -- last searched 11/1/2024

Key Descriptions

  • 19 item, self-reported
  • Total Minimum Score: 3
  • Total Maximum Score: 21
  • Item scores are summed
  • Item-level scores are from 1-7; determined by selecting the response option best applicable to the patient

Number of Items

19

Equipment Required

  • Pencil/pen
  • Questionnaire

Time to Administer

5 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Dr. Alaina Bell, PT, DPT, Emma Burch, SPT, Kim Khong, SPT, Haley Langston, SPT, & Christopher Nguyen, SPT, PCOM Georgia

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Emotion

Professional Association Recommendation

None found -- last searched 11/1/2024

Considerations

  • There are French, Norwegian, Swedish, Turkish versions of the LCQ for COPD.
  • There are Dutch, Korean, Polish, Thai versions of the LCQ for chronic cough.
  • A German version of the LCQ has been validated for sarcoidosis.
  • There is a Mandarin-Chinese version of the LCQ for bronchiectasis & non-small cell lung cancer (NSCLC).
  • There is a Spanish version of the LCQ for non-cystic fibrosis bronchiectasis. 
  • The LCQ is also used as a cough-specific QOL tool for assessing the baseline and clinical outcomes in COVID & ILD populations; however, more clinical studies are needed to determine the validity & reliability of the LCQ for these two conditions. 
  • The LCQ can be used together with the SF-36 because it measures health-related quality of life (HRQL) aspects that are not covered by the SF-36.

Pulmonary Diseases

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Standard Error of Measurement (SEM)

Chronic Obstructive Pulmonary Disease (COPD) with chronic cough: (Berkhof et al., 2012; n = 54; mean age = 68 (10) years; mean pack-years = 36 (22))

  • SEM for Physical (n = 54): 0.212
  • SEM for Psychological (n = 54): 0.458
  • SEM for Social (n = 54): 0.450
  • SEM for Total (n = 54): 0.792

 

COPD: (Sönnerfors et al., 2018; n = 86; mean age = 71.33 (6.8) years; female = 63; Swedish translation of LCQ)

  • SEM for Physical (n = 86): 0.29
  • SEM for Psychological (n = 86): 0.44
  • SEM for Social (n = 86): 0.34
  • SEM for Total (n = 86): 0.88

 

Non-cystic Fibrosis Bronchiectasis: (Munoz et al, 2016; = 259, mean age = 58.37 (18.1) years, female = 154 (59%), Spanish translation of LCQ)

  • Physical: SEM = 0.494
  • Psychological: SEM = 0.532
  • Social: SEM = 0.558
  • Total: SEM = 1.214

Minimal Detectable Change (MDC)

COPD with chronic cough: (Berkhof et al., 2012)

  • Physical: MDC 90 = 0.49; MDC95 = 0.59; MDC99 = 0.77
  • Psychological: MDC90 = 1.07; MDC95 = 1.27; MDC = 1.67
  • Social: MDC90 = 1.05; MDC95 = 1.25; MDC99 = 1.64
  • Total: MDC90 = 1.84; MDC95 = 2.20; MDC99 = 2.89

 

COPD: (Sönnerfors et al, 2018; Swedish translation of LCQ)

  • MDC for Physical (n = 86): 0.804
  • MDC for Psychological (n = 86): 1.22
  • MDC for Social (n = 86): 0.942
  • MDC for Total (n = 86): 2.44

 

Non-cystic Fibrosis Bronchiectasis: (Munoz et al, 2016; Spanish translation of LCQ)

  • Physical: MDC90 = 1.15, MDC95 = 1.37, MDC99 = 1.80
  • Psychological: MDC90 = 1.24, MDC95 = 1.48, MDC99 = 1.94
  • Social: MDC90 = 1.30, MDC95 = 1.55, MDC99 = 2.03
  • Total: MDC90 = 2.82, MDC95 = 3.37, MDC99 = 4.42

Minimally Clinically Important Difference (MCID)

Non-cystic Fibrosis Bronchiectasis: (Munoz et al, 2016; Spanish translation of LCQ)

  • MCID = 1.3 for Total LCQ score

Test/Retest Reliability

COPD with chronic cough: (Berkhof et al, 2012; tested at 0 and 2 weeks)

  • Excellent test-retest reliability Physical & Total domains (ICC’s = 0.93 & 0.92, respectively)
  • Acceptable test-retest reliability for Psychological (ICC = 0.79) and Social (ICC = 0.88) domains

 

COPD: (Kurhan et al., 2018; = 150 (75 COPD patients over age 40, mean age = 62.32 (7.8), female = 94.6%; and 75 control subjects, mean age = 55.45 (8.0), female = 50.7%; Turkish translation of LCQ)

  • Acceptable test-retest reliability for LCQ domains and total (ICC = 0.71-0.89)

 

COPD: (Sönnerfors et al, 2018; Swedish translation of LCQ)

  • Acceptable test-retest reliability (ICC > 0.8)

 

Non-cystic Fibrosis Bronchiectasis: (Murray et al, 2009; = 120 (51 with severe bronchiectasis, male = 25 (49%), median age = 68 (IQR = 60-74); 29 w/moderate, male = 10 (34.5%), median age = 69.5 (IQR = 56.2-77.2); and 40 w/mild, male = 16 (40%), median age = 67 (IQR = 59-76.7); test repeated 6 months after completion of initial questionnaire)

  • Excellent test-retest reliability for Total LCQ score (ICC = 0.96)

 

Non-cystic Fibrosis Bronchiectasis: (Munoz et al, 2016; Spanish translation of LCQ)

  • Acceptable test-retest reliability for LCQ domains and Total:
    • Physical (ICC = 0.87, 95% CI = 0.84-0.90)
    • Psychological (ICC = 0.82, 95% CI = 0.77-0.86)
    • Social (ICC = 0.79, 95% CI = 0.73-0.84)
    • Total (ICC = 0.84, 95% CI = 0.79-0.87)

 

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Chronic Cough: (Birring et al., 2003; = 104; chronic cough outpatients)

  • Physical (SEM = 0.249), Psychological (SEM = 0.297), Social (SEM = 0.326), Total (SEM = 0.188)

 

Unexplained Chronic Cough: (Nguyen et al., 2022; = 253, mean age = 60.2 (9.9), female = 76.3%; 97.6 % had used medication to treat their cough within 30 days of screening)

  • Physical (SEM = 0.42), Psychological (SEM = 0.60), Social (SEM = 0.85), Total (SEM = 1.51)

Minimal Detectable Change (MDC)

Chronic Cough LCQ: (Birring et al., 2003)

  • Physical: MDC90 = 0.58, MDC95 = 0.69, MDC99 = 0.91
  • Psychological: MDC90 = 0.69, MDC95 = 0.82, MDC99 = 1.08
  • Social: MDC90 = 0.76, MDC95 = 0.90, MDC99 = 1.1
  • Total: MDC90 = 0.44, MDC95 = 0.52, MDC99 = 0.68

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Physical: MDC90 = 0.98, MDC95 = 1.16, MDC99 = 1.53
  • Psychological: MDC90 = 1.40, MDC95 = 1.66, MDC99 = 2.19
  • Social: MDC90 = 1.98, MDC95 = 2.36, MDC99 = 3.10
  • Total: MDC90 = 3.51, MDC95 = 4.19, MDC99 = 5.50

Minimally Clinically Important Difference (MCID)

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Within-patient change of ≥ 1.3 points on LCQ total score 

Test/Retest Reliability

Unexplained Chronic Cough: (Nguyen et al., 2022; = 61)

  • Acceptable test-retest reliability for all LCQ domains and total:
    • Physical (ICC = 0.75)
    • Psychological (ICC = 0.80)
    • Social (ICC = 0.75)
    • Total (ICC = 0.80)

Interrater/Intrarater Reliability

Chronic Cough: (Birring et al., 2003) 

  • Excellent intra-rater reliability for all LCQ domains and total:
    • Physical (ICC = 0.93)
    • Psychological (ICC = 0.90)
    • Social (ICC = 0.88)
    • Total (ICC = 0.96)

Internal Consistency

Chronic Cough LCQ: (Birring et al., 2003)

  • Adequate: Physical (α = 0.79)
  • Excellent: Psychological (α = 0.89), Social (α = 0.85), Total (α = 0.92)

 

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Adequate: Physical (α = 0.703-0.770)
  • Excellent: Psychological (α = 0.814-0.914), Social (α = 0.777-0.892), Total (α = 0.884-0.940)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Chronic Cough: (Birring et al., 2003; LCQ2 is the final 19-item version of LCQ)

  • Excellent negative correlation between LCQ2 Total score and Cough Visual Analogue Scale (VAS) (= -0.72)
  • Adequate correlations between LCQ2 Total score and SGRQ Total (= -0.54) and LCQ2 Total score and SF-36 Total (=0.46)

 

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Excellent: Physical (r = 0.77), Psychological (r = 0.82), Social (r = 0.81), Total (r = 0.84)

 

Construct Validity

Convergent validity:

 

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Excellent negative correlations between LCQ Scores at Week 4 and Cough Severity Diary (CSD) Total score: Physical (r = -0.69), Psychological (r = -0.69), Social (r = -0.73), Total (r = -0.76)

 

Discriminant validity:

 

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Significant ability of LCQ Total score at baseline to differentiate among known CSD Total score groups at baseline

Known-groups validity: LCQ scores at baseline by CSD total score groups at baselinea

LCQ Domain

CSD tertile Group 1 Mean (SE) 

CSD tertile Group 2 Mean (SE)

CSD tertile Group 3 Mean (SE)

Overall F value (p)

Physical

5.0 (0.10)

4.6 (0.10)

3.7 (0.10)

40.20 (<0.0001)

Psychological

4.3 (0.13)

3.6 (0.12)

3.2 (0.13)

16.41 (<0.0001)

Social

4.3 (0.13)

3.5 (0.12)

3.0 (0.12)

29.82 (<0.0001)

Total score

13.5 (0.30)

11.7 (0.29)

9.9 (0.30)

35.68 (<0.0001)

CSD = Cough Severity Diary; LCQ = Leicester Cough Questionnaire; SE = Standard error

aParticipants were stratified into tertiles using sample distribution according to CSD score at baseline. Group 1 (= 76) = participants with the lowest CSD scores (i.e., lowest cough severity), Group 2 (= 85) = participants in the middle third of CSD scores, and Group 3 (= 78) = those with the highest CSD scores (i.e., highest cough severity). 

 

Floor/Ceiling Effects

Chronic Cough: (Birring et al., 2003)

  • Adequate: Ceiling effect for 1 item on LCQ1 (makes up 2% of total items)

 

Unexplained Chronic Cough: (Nguyen et al., 2022)

  • Excellent: No floor or ceiling effects

 

Responsiveness

Chronic Cough: (Birring et al., 2003)

  • Large Change: LCQ Domains -  Physical (effect size = 1.00), Psychological (effect size = 1.75), Social (effect size = 0.84), Total (effect size = 1.68)
  • Large Change: Cough VAS (effect size = 3.19)

 

Unexplained Chronic Cough: (Nguyen et al., 2022) 

  • Patient Global Impression of Change (PGIC) Scores: 
    • Large Change: PGIC score of 1 or 2 (very much improved, much improved) - effect size = 1.9
    • Moderate Change: PGIC score of 3 (minimally improved) - effect size = 0.8
    • Moderate Change: 4 (no change) - effect size = 0.2
    • Moderate Change: 5 (worse) - effect size = -0.2
    • Moderate Change: 6 or 7 (much worse, very much worse) - effect size = -0.8
  • Awake Cough Frequency: 
    • Large Change: ≥ 30% reduction - effect size = 1.5
    • Moderate Change: < 30% reduction - effect size = 0.4
    • Large Change: ≥ 50% reduction - effect size = 1.8
    • Moderate Change: < 50% reduction - effect size = 0.5
    • Large Change: ≥ 70% reduction -  effect size = 2.2
    • Moderate Change: < 70% reduction - effect size = 0.7

 

Bibliography

Berkhof, F. F., Boom, L. N., ten Hertog, N. E., Uil, S. M., Kerstjens, H. A., & van den Berg, J. W. (2012). The validity and precision of the Leicester Cough Questionnaire in COPD patients with chronic cough. Health and quality of life outcomes, 10, 4. https://doi.org/10.1186/1477-7525-10-4

Birring, S. S., Prudon, B., Carr, A. J., Singh, S. J., Morgan, M. D., & Pavord, I. D. (2003). Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax, 58(4), 339–343. https://doi.org/10.1136/thorax.58.4.339

Kurhan, F., Göktalay, T., Havlucu, Y., Sarı, S., Yorgancıoğlu, A., Çelik, P., & Şakar Coşkun, A. (2018). The validity and reliability of the Turkish version of the Leicester Cough Questionnaire in COPD patients. Turkish Journal of Medical Sciences, 48(4), 811–816. https://doi.org/10.3906/sag-1801-27

Muñoz G, Buxó M, de Gracia J, et al. (2016). Validation of a Spanish version of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis. Chron Respir Dis., 13(2):128-136. http://doi.org/10.1177/1479972316632005

Murray, M. P., Turnbull, K., MacQuarrie, S., Pentland, J. L., & Hill, A. T. (2009). Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis. The European respiratory journal, 34(1), 125–131. https://doi.org/10.1183/09031936.00160508

Nguyen AM, Schelfhout J, Muccino D, et al. (2022). Leicester Cough Questionnaire validation and clinically important thresholds for change in refractory or unexplained chronic cough. Ther Adv Respir Dis., 16: 1-13. http://doi.org/10.1177/17534666221099737

Sönnerfors, P., Faager, G., & Einarsson, U. (2018). Translation of the Leicester Cough Questionnaire into Swedish, and validity and reliability in chronic obstructive pulmonary disease. Disability and rehabilitation, 40(22), 2662–2670. https://doi.org/10.1080/09638288.2017.1353648

Vodanovich, D. A., Bicknell, T. J., Holland, A. E., et al. (2015). Validity and Reliability of the Chronic Respiratory Disease Questionnaire in Elderly Individuals with Mild to Moderate Non-Cystic Fibrosis Bronchiectasis. Respiration, 90(2):89-96. http://doi.org/10.1159/000430992