Evaluation of the Cough Hypersensitivity Questionnaire with Likert scale responses

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Introduction: The Cough Hypersensitivity Questionnaire (CHQ) contains 22 items, measuring laryngeal sensations (n=6) and triggers (n=16) associated with coughing. This was previously validated with a binary scale (yes/no) in refractory chronic cough (RCC). A Likert scale may provide more detailed profiling of cough hypersensitivity features and be more responsive to change. Aim: To investigate construct validity, reliability and repeatability of the CHQ with Likert scale responses (CHQ-L). Methods: A 6-point Likert scale (0-never, 5-always) was applied to the CHQ after steering group input. Consecutive patients with RCC from a tertiary (NEuroCOUGH CRC) site completed: CHQ-L (possible scores: sensations, 0-30; triggers, 0-80; total, 0-110), cough severity visual analogue scale (VAS, 0-100mm), Patient Global Impression of Severity (PGI-S, 0-5) and the Leicester Cough Questionnaire of cough-specific health status (LCQ, 3-21). Participants were invited to repeat the CHQ-L, PGI-S and VAS after 14 days. Results: 68 participants were recruited; 74% female, mean (SD) age 60 (11) years. Mean CHQ-L sensations score 14 (6), CHQ-L triggers 33 (13), CHQ-L total 48 (16), cough severity VAS 55 (24) mm; median (IQR) PGI-S 3 (3-4), LCQ total score 10.9 (8.7-13.3). CHQ-L total score was associated with severity VAS (r=0.37), PGI-S (ρ =0.39) and LCQ (ρ=-0.61); all p<0.01. Internal consistency reliability was good (Cronbach’s α 0.86), as was repeatability (n=18; ICC 0.80; 95% CI 0.54-0.92). Discussion: The CHQ-L demonstrates good construct validity, internal consistency, and repeatability in RCC. The Likert format may provide more granular phenotyping of cough hypersensitivity compared to the binary version. Responsiveness and potential thresholds for identifying patients with RCC await definition.

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