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      The relationship between cough-specific quality of life and abdominal muscle endurance, fatigue, and depression in patients with COPD

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          Cough is a prevalent symptom that impacts quality of life in COPD. The aim of this study was to assess the relationship between cough-specific quality of life, abdominal muscle endurance, fatigue, and depression in stable patients with COPD.


          Twenty-eight patients with COPD (mean age 60.6±8.7 years) referred for pulmonary rehabilitation participated in this cross-sectional study. Sit-ups test was used for assessing abdominal muscle endurance. Leicester Cough Questionnare (LCQ) was used to evaluate symptom-specific quality of life. Fatigue perception was evaluated with Fatigue Impact Scale (FIS). Beck Depression Inventory (BDI) was used for assessing depression level.


          The LCQ total score was significantly associated with number of sit-ups; BDI score; FIS total; physical, cognitive, and psychosocial scores ( P<0.05). Scores of the LCQ physical, social, and psychological domains were also significantly related with number of sit-ups, FIS total score, and BDI score ( P<0.05). FIS total score and number of sit-ups explained 58% of the variance in LCQ total score ( r=0.76, r 2=0.577, F(2–20)=12.296, P<0.001).


          Chronic cough may adversely affect performance in daily life due to its negative effect on fatigue and decrease abdominal muscle endurance in patients with COPD. Decreased cough-related quality of life is related with increased level of depression in COPD patients. Effects of increased abdominal muscle endurance and decreased fatigue in COPD patients with chronic cough need further investigation.

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          Most cited references 41

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          The diagnosis and management of chronic cough.

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            Impact of chronic cough on quality of life.

            Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects. The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered. The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean +/- SD of 8.6 +/- 4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (P<.02). After cough disappeared with treatment, ACOS complaints decreased to a mean +/- SD of 1.9 +/- 3.2 (P<.0001) as did total (mean +/- SD, 4.8 +/- 4.5 to 1.8 +/- 2.2) (P= .004), psychosocial (mean +/- SD, 4.2 +/- 6.8 to 0.8 +/- 2.3) (P = .004), and physical (mean +/- SD, 2.2 +/- 2.9 to 0.9 +/- 1.8) (P = .05) SIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained. Chronic cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of chronic cough.
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              Evaluation of a cough-specific quality-of-life questionnaire.

              To psychometrically evaluate a cough-specific quality-of-life questionnaire (CQLQ) in adults. Prospective evaluation of CQLQ using three different cohorts of adult subjects with cough. Academic tertiary-care ambulatory medical facilities. One hundred fifty-four subjects complaining of chronic cough, 30 of acute cough, and 31 smokers with cough. Self-administration of the CQLQ in acute coughers, smokers, and chronic coughers before and after therapy. Psychometric analyses including factor analysis (FA), and assessments of reliability and validity. Acute and chronic cough data were subjected to FA, and the Cronbach alpha and interitem correlations were computed. FA of chronic and acute cough data (n = 184) revealed six subscales. The Cronbach alpha for the total CQLQ was 0.92, and it was 0.62 to 0.86 (mean, 0.76) for the six subscales. Interitem correlations for the total CQLQ ranged from -0.06 to 0.72, with a mean of 0.28. Test-retest reliability in 52 chronic coughers demonstrated nonsignificant changes with readministration of the questionnaire, and the intraclass correlation for total CQLQ was 0.89, and for the subscales the range was 0.75 to 0.93. Analysis of variance followed by tests of contrasts among all possible pairings of chronic coughers, acute coughers, and smokers showed significant differences (p < or = 0.001) among the groups. Posttreatment cure scores were significantly lower (p < or = 0.001) than pretreatment scores in 24 chronic coughers. The 28-item CQLQ has dimensionality that is consistent with a cough-specific quality-of-life instrument. It is a valid and reliable method by which to assess the impact of cough on the quality of life of chronic and acute coughers, and the efficacy of cough therapies in chronic coughers.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                07 September 2015
                : 10
                : 1829-1835
                [1 ]Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
                [2 ]School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
                [3 ]Department of Chest Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
                Author notes
                Correspondence: Ebru Calik-Kutukcu, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100 Samanpazari, Ankara, Turkey, Tel +90 312 305 1577 extension 178, Fax +90 312 305 2012, Email ebrucalk85@
                © 2015 Arikan et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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