D2.155 - Mapping the Architecture and Spectrum of the Cough Hypersensitivity Questionnaire Across Respiratory Diseases

Cough hypersensitivity is increasingly being recognized as a key mechanism underlying chronic cough across diverse etiologies. The Cough Hypersensitivity Questionnaire (CHQ) was recently developed to systematically assess the hallmark features of cough hypersensitivity, including specific triggers and abnormal sensory perceptions. This study aimed to investigate the structural validity and clinical relevance of the CHQ in diverse respiratory diseases. 

We prospectively enrolled 300 adults with chronic cough from various respiratory centers. The participants completed four cough-related questionnaires: the Numeric Rating Scale (NRS), the Leicester Cough Questionnaire (LCQ), the Cough Assessment Test (COAT), and the CHQ. Spearman’s correlation and network analyses were used to evaluate associations between CHQ items and other cough-related measures, with subgroup analyses by disease etiology.

The CHQ showed a heterogeneous and disease-specific association with conventional cough assessment tools. Triggers, including perfumes and smoke, correlated with LCQ hypersensitivity items, while the sensation item, such as “urge to cough,” showed broad correlations across physical, psychological, and social domains. Socially mediated triggers (e.g., talking) were aligned with LCQ social interference items. In contrast, items such as hot air, dampness, laughter, and eating/drinking had minimal external associations. Internal CHQ correlations were relatively sparse, and no significant associations were observed with NRS scores, indicating a dissociation between hypersensitivity features and perceived severity. Subgroup analyses revealed disease-specific differences in the hypersensitivity burden and correlation patterns. The CHQ scores exhibited limited associations with the conventional assessment tools for chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis, with only isolated item-level correlations. In contrast, asthma and bronchiectasis showed broader and more consistent associations.

The CHQ captures distinct features of cough hypersensitivity that are not fully reflected in conventional cough severity or quality-of-life measures. The selective and etiology-specific associations support its construct validity and potential utility in phenotyping chronic cough.