Is Your Cough Getting Better?

203 Undoubtedly, cough is one of the most common symptoms that make people visit physicians for its treatment. It is also apparent that management of chronic cough is not so simple. Underlying causative diseases are diverse, pathogenic mechanism is not clear, and patients' complaints from personal subjective feelings often make physicians even more frustrated. Furthermore , some patients fail to comprehensively explain their symptoms, and they do not score the severity of their symptoms exactly on a standardized scale. Indeed, precise assessment of the severity and characteristics of cough would be helpful in evaluating the effectiveness of certain therapeutic approaches. Unfortunately, physicians do not have perfectly reliable tools to objectively measure treatment outcomes of cough patients. In clinical practice, physicians, who eagerly want to know about cough severity in patients with chronic cough, frequently ask the patients " Is your cough getting better? " In addition, physicians modify the management plan based on patients' description of symptom changes. This is a usual pattern in clinical practice for cough patients. It may be alright for physicians seeing patients in their clinics to simply ask the patients about changes in cough severity to 1 or 2 weeks after prescribing cough medications. However, in clinical studies or trials of new antitussive drugs, it is of no value in obtaining clinical information to simply ask " Is your cough getting better? " A validated way to objectively measure cough in quantity and quality is necessary. An excellent review article about tools to assess outcomes in clinical studies on cough has recently been published by the CHEST Expert Cough Panel. 1 Originally, tools to assess the magnitude of cough were developed to evaluate the efficacy of new antitussive medications because valid tools should be used to measure outcomes of administration of antitussive agents in clinical trials. This panel suggests that assessment of cough consider various aspects of cough, such as severity, cough-specific quality of life (QoL), frequency, and sensitivity. It is recommended that validated and reliable cough-specific health-related QoL questionnaires be used to assess cough severity of patients, and it is specifically suggested that Cough-Specific Quality-of-Life Questionnaire (CQLQ) and Leicester Cough Questionnaire (LCQ) be used because they are most extensively studied and found to be valid and reliable. Although QoL surpasses other measures in assessing cough, questionnaires are usually developed solely based on patients' input, and the methodology is somewhat subjective. Thus, tools to objectively …