Introduction
The Leicester Cough Questionnaire (LCQ) is a pivotal tool for evaluating the impact of chronic cough on patients’ quality of life. Since its development in 2003 by S S Birring, B Prudon, A Carr, S Singh, M Morgan, I Pavord, the LCQ has gained prominence in pulmonology, with over 1,200 citations on Google Scholar, underscoring its relevance in clinical trials and longitudinal studies (Birring et al., 2003). Specifically designed for adults aged 18 and older, this self-administered questionnaire assesses physical, psychological, and social domains affected by chronic cough. The Leicester Cough Questionnaire © 2001 is copyrighted by Birring et al., and all rights are reserved by the original authors. Consequently, it provides researchers and clinicians with actionable insights to improve patient outcomes.
This article explores the LCQ’s features, scoring, applications, and limitations, offering a comprehensive resource for experts in respiratory medicine.
Key Features of the Leicester Cough Questionnaire (LCQ)
Purpose and Use
The LCQ measures the health-related quality of life in patients with chronic cough, making it a critical tool for clinical trials and longitudinal studies. Unlike generic respiratory questionnaires, such as the St. George’s Respiratory Questionnaire (SGRQ), the LCQ focuses specifically on cough-related impacts, offering precision in assessing treatment efficacy.
Target Population
Designed for adults aged 18 and older, the LCQ applies to diverse groups, including young adults, middle-aged adults, and seniors. However, it is not validated for acute cough or pediatric populations, limiting its scope to chronic cough in adults.
Structure
The LCQ comprises 19 items divided into three domains:
- Physical (8 items): Covers symptoms like chest/stomach pain, bothersome phlegm, tiredness, and sleep disturbances.
- Psychological (7 items): Evaluates emotional burdens, including embarrassment, anxiety, and concerns about serious illness.
- Social (4 items): Assesses disruptions in daily work, conversations, and relationships due to chronic cough.
Each item uses a 7-point Likert scale, ensuring nuanced data collection. Moreover, the questionnaire takes approximately 5–10 minutes to complete, enhancing its practicality in clinical settings.
Scoring Method
The LCQ asks patients 19 questions analyzing their cough over the previous two weeks and employs a 7-point Likert scale (1 = all the time, 7 = never) for each item. Notably, items 4 and 15 require reverse scoring (8 − original score). To calculate scores:
- Domain Scores: Sum the scores for items in each domain (Physical, Psychological, Social) and divide by the number of items (8, 7, and 4, respectively). Each domain score ranges from 1 to 7.
- Total Score (LCQ-TS): Sum the three domain scores, yielding a range of 3 (worst quality of life) to 21 (best quality of life).
Interpretation:
- Mild: 17.54–21.00
- Moderate: 12.29–17.53
- Severe: 3.00–12.28
A minimal clinically important difference (MID) of 1.3 points indicates meaningful improvement. Consequently, this scoring system allows clinicians to track treatment progress effectively.
Administration Format
The LCQ takes 5-10 minutes to administer, making it highly efficient. It can be conducted via:
- Paper-based forms
- Digital (Online) platforms
- Mobile app
Its self-administered format, requiring no specialized training, enhances its practicality for busy clinical environments.
Applications of Leicester Cough Questionnaire (LCQ)
The LCQ serves multiple purposes in pulmonology:
- Monitoring: Tracks changes in cough impact over time, particularly in response to interventions.
- Treatment Planning: Guides clinicians in tailoring therapies based on patient-reported outcomes.
- Research: Widely used in clinical trials to evaluate treatment efficacy, as evidenced by its extensive citations.
For instance, its responsiveness to change makes it ideal for assessing novel therapies in chronic cough management. Furthermore, its focused design outperforms broader tools like the SGRQ in cough-specific studies.
Languages and Availability
The LCQ is available in multiple languages, including:
- Arabic
- English
- Mandarin Chinese
- Spanish
- French
- Russian
- German
- Portuguese
- Japanese
- Hindi
- Along with over 45 translations.
This multilingual accessibility supports its use in global research and clinical practice, ensuring broad applicability.
The LCQ is free for non-commercial use under an open-access license, requiring no licensing fees for academic or clinical purposes. However, commercial use necessitates permission from the authors. For inquiries, contact Dr. S. S. Birring at sb134@le.ac.uk. This open-access availability enhances its adoption in research and clinical settings.
Reliability and Validity
The Leicester Cough Questionnaire (LCQ) is recognized as a highly reliable and valid instrument for assessing the impact of chronic cough on quality of life. Its psychometric strength is evidenced by a Cronbach’s alpha ranging from 0.79 to 0.89, indicating excellent internal consistency. Additionally, it has shown strong test-retest reliability, ensuring stability over time.
Validation Study:
Limitations and Considerations
However, despite its strengths, the LCQ has a few limitations:
- Self-report: Patients may underreport symptoms due to social desirability bias.
- Not Validated for Acute Cough: The LCQ is specific to chronic cough, limiting its use in acute settings.
- Social Desirability Bias: Respondents may minimize answers to meet perceived social expectations, reducing accuracy.
Nevertheless, its robust validation and focused design make it a cornerstone in cough-related research.
Other Versions and Related Questionnaires
Alternative Versions of NPQ-10
- LCQ-acute: An adapted version for assessing acute cough, though not as widely validated as the original LCQ.
Complementary Questionnaires
- Cough Quality of Life Questionnaire (CQLQ): Measures cough-specific quality of life but with a broader focus.
- St. George’s Respiratory Questionnaire (SGRQ): Assesses general respiratory health, less specific to cough.
Additional Resources
For more information on the LCQ and to access the full questionnaire, visit the following resources:
- Access the LCQ as a PDF through this link and link.
- For inquiries, contact Dr. S. S. Birring at sb134@le.ac.uk.
- For additional LCQ resources, consult Oxford University Press.
- Further studies: Jieun et al., 2024, Heikki et al., 2024, Jane et al., 2022, A A Raj et al., 2009.
Frequently Asked Questions (FAQ)
- Who can use the LCQ?
Clinicians, researchers, and healthcare providers use the LCQ for adults aged 18 and older with chronic cough. - How long does it take to complete the LCQ?
Patients typically complete the LCQ in 5–10 minutes, making it efficient for clinical and research settings. - How is the LCQ administered?
The LCQ supports paper-based, digital, digital (online) and mobile app formats, offering flexibility for diverse settings. - Is there any cost to using the LCQ?
The LCQ is free for non-commercial use. Commercial or funded projects require permission from the authors.
A word from ResRef about Leicester Cough Questionnaire (LCQ)
Studies have shown that the Leicester Cough Questionnaire (LCQ) is reliable, valid, reproducible, and responsive in measuring the impact of chronic cough in adults. Whether you are a researcher evaluating treatment outcomes or a clinician improving patient care, the LCQ provides critical insights into cough-related quality of life. Consequently, it leads to better outcomes and informed treatment decisions.
References
- Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003 Apr;58(4):339-43. doi: 10.1136/thorax.58.4.339. PMID: 12668799; PMCID: PMC1746649. (link)
- Nguyen AM, Schelfhout J, Muccino D, Bacci ED, La Rosa C, Vernon M, Birring SS. Leicester Cough Questionnaire validation and clinically important thresholds for change in refractory or unexplained chronic cough. Ther Adv Respir Dis. 2022 Jan-Dec; 16:17534666221099737. doi: 10.1177/17534666221099737. PMID: 35614875; PMCID: PMC9149626. (link)
- Kang J, Moon JY, Kim DK, Kim JW, Jang SH, Kwon JW, Lee BJ, Koo HK. Reclassification of items in the Leicester Cough Questionnaire: Correlation analysis. Respir Investig. 2024 Nov;62(6):1150-1156. doi: 10.1016/j.resinv.2024.09.017. Epub 2024 Oct 10. PMID: 39393344. (link)
- Koskela HO, Kaulamo JT, Lätti AM. Severity grading of the Leicester Cough Questionnaire in chronic cough. ERJ Open Res. 2024 Jul 29;10(4):00142-2024. doi: 10.1183/23120541.00142-2024. PMID: 39076531; PMCID: PMC11284591. (link)
- Reynolds JE, Jetté ME, Wright ML, Sundar KM, Gillespie AI, Slovarp LJ. Normative Values for the Leicester Cough Questionnaire in Healthy Individuals. Ann Otol Rhinol Laryngol. 2023 Jun;132(6):705-708. doi: 10.1177/00034894221112517. Epub 2022 Jul 14. PMID: 35833581. (link)
- Raj AA, Pavord DI, Birring SS. Clinical cough IV:what is the minimal important difference for the Leicester Cough Questionnaire? Handb Exp Pharmacol. 2009;(187):311-20. doi: 10.1007/978-3-540-79842-2_16. PMID: 18825348. (link)
