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Abstract：
BACKGROUND: Refractory or unexplained chronic cough (RUCC) is a common clinical problem with no effective diagnostic tools. The Sensations and Triggers Provoking Cough questionnaire (TOPIC) was developed to characterise cough in RUCC versus cough in other conditions.
METHODS: Content analysis of participant interviews discussing the sensations and triggers of chronic cough informed TOPIC development. Participants with chronic cough completed the draft-TOPIC (a subset repeating 5-7 days later), St George\'s Respiratory Questionnaire (SGRQ), Cough Severity Diary (CSD) and Global Rating of Change Scale. The draft-TOPIC item list was reduced in hierarchical and Rasch analysis to refine the questionnaire to the TOPIC.
RESULTS: 49 items describing the triggers and sensations of cough were generated from participant interviews (RUCC n=14, chronic obstructive pulmonary disease (COPD) n=11, interstitial lung disease (ILD) n=10, asthma n=11, bronchiectasis n=3, cystic fibrosis n=7). 140 participants (median age 60.0 (19.0-88.0), female 56.4%; RUCC n=39, ILD n=38, asthma n=45, COPD n=6, bronchiectasis n=12) completed draft-TOPIC, where items with poor \'fit\' for RUCC were removed to create TOPIC (8 trigger items, 7 sensation items). Median TOPIC score was significantly higher in RUCC (37.0) vs ILD (24.5, p=0.009) and asthma (7.0, p<0.001), but not bronchiectasis (20.0, p=0.318) or COPD (18.5, p=0.238), likely due to small sample sizes. The Rasch model demonstrated excellent fit in RUCC (χ2=22.04, p=0.85; PSI=0.88); as expected. When all participant groups were included, fit was no longer demonstrated (χ2=66.43, p=0.0001, PSI=0.89) due to the increased heterogeneity (CI=0.077). TOPIC correlated positively with SGRQ (r=0.47, p<0.001) and CSD (r=0.63, p<0.001). The test-retest reliability of TOPIC (intraclass correlation coefficient) was excellent (r=0.90, p<0.001).
CONCLUSIONS: High TOPIC scores in the RUCC patients suggest their cough is characterised by specific sensations and triggers. Validation of TOPIC in cough clinics may demonstrate value as an aid to identify features of RUCC versus cough in other conditions.
METHODS: Content analysis of participant interviews discussing the sensations and triggers of chronic cough informed TOPIC development. Participants with chronic cough completed the draft-TOPIC (a subset repeating 5-7 days later), St George\'s Respiratory Questionnaire (SGRQ), Cough Severity Diary (CSD) and Global Rating of Change Scale. The draft-TOPIC item list was reduced in hierarchical and Rasch analysis to refine the questionnaire to the TOPIC.
RESULTS: 49 items describing the triggers and sensations of cough were generated from participant interviews (RUCC n=14, chronic obstructive pulmonary disease (COPD) n=11, interstitial lung disease (ILD) n=10, asthma n=11, bronchiectasis n=3, cystic fibrosis n=7). 140 participants (median age 60.0 (19.0-88.0), female 56.4%; RUCC n=39, ILD n=38, asthma n=45, COPD n=6, bronchiectasis n=12) completed draft-TOPIC, where items with poor \'fit\' for RUCC were removed to create TOPIC (8 trigger items, 7 sensation items). Median TOPIC score was significantly higher in RUCC (37.0) vs ILD (24.5, p=0.009) and asthma (7.0, p<0.001), but not bronchiectasis (20.0, p=0.318) or COPD (18.5, p=0.238), likely due to small sample sizes. The Rasch model demonstrated excellent fit in RUCC (χ2=22.04, p=0.85; PSI=0.88); as expected. When all participant groups were included, fit was no longer demonstrated (χ2=66.43, p=0.0001, PSI=0.89) due to the increased heterogeneity (CI=0.077). TOPIC correlated positively with SGRQ (r=0.47, p<0.001) and CSD (r=0.63, p<0.001). The test-retest reliability of TOPIC (intraclass correlation coefficient) was excellent (r=0.90, p<0.001).
CONCLUSIONS: High TOPIC scores in the RUCC patients suggest their cough is characterised by specific sensations and triggers. Validation of TOPIC in cough clinics may demonstrate value as an aid to identify features of RUCC versus cough in other conditions.
摘要：
背景：难治性或无法解释的慢性咳嗽（RUCC）是一个常见的临床问题，没有有效的诊断工具。开发了“感觉和触发引发咳嗽问卷”（TOPIC），以表征RUCC中的咳嗽与其他疾病中的咳嗽。
方法：讨论慢性咳嗽的感觉和触发因素的参与者访谈的内容分析告知TOPIC发展。慢性咳嗽的参与者完成了TOPIC草案（5-7天后重复的子集），圣乔治呼吸问卷(SGRQ)，咳嗽严重程度日记(CSD)和全球变化量表评级。在分层和Rasch分析中减少了TOPIC项目清单草案，以将问卷细化为TOPIC。
结果：49项描述咳嗽的诱因和感觉的项目来自参与者访谈（RUCCn=14，慢性阻塞性肺疾病（COPD）n=11，间质性肺疾病（ILD）n=10，哮喘n=11，支气管扩张n=3，囊性纤维化n=7）。140名参与者（中位年龄60.0（19.0-88.0），女性56.4%；RUCCn=39，ILDn=38，哮喘n=45，COPDn=6，支气管扩张n=12）完成草案-TOPIC，其中删除了RUCC的“fit”较差的项目以创建TOPIC（8个触发项目，7个感觉项目)。RUCC（37.0）与ILD（24.5，p=0.009）和哮喘（7.0，p<0.001）相比，TOPIC评分中位数明显更高，但不是支气管扩张（20.0，p=0.318）或COPD（18.5，p=0.238），可能是由于样本量小。Rasch模型在RUCC中表现出优异的拟合(χ2=22.04,p=0.85;PSI=0.88);如预期的那样。当包括所有参与者组时，由于异质性增加（CI=0.077），不再证明拟合（χ2=66.43，p=0.0001，PSI=0.89）。TOPIC与SGRQ(r=0.47,p<0.001)和CSD(r=0.63,p<0.001)呈正相关。TOPIC（组内相关系数）的重测可靠性非常好（r=0.90，p<0.001）。
结论：RUCC患者的高TOPIC评分表明他们的咳嗽具有特定的感觉和触发因素。咳嗽诊所中TOPIC的验证可能证明其有助于识别RUCC与其他条件下咳嗽的特征。
方法：讨论慢性咳嗽的感觉和触发因素的参与者访谈的内容分析告知TOPIC发展。慢性咳嗽的参与者完成了TOPIC草案（5-7天后重复的子集），圣乔治呼吸问卷(SGRQ)，咳嗽严重程度日记(CSD)和全球变化量表评级。在分层和Rasch分析中减少了TOPIC项目清单草案，以将问卷细化为TOPIC。
结果：49项描述咳嗽的诱因和感觉的项目来自参与者访谈（RUCCn=14，慢性阻塞性肺疾病（COPD）n=11，间质性肺疾病（ILD）n=10，哮喘n=11，支气管扩张n=3，囊性纤维化n=7）。140名参与者（中位年龄60.0（19.0-88.0），女性56.4%；RUCCn=39，ILDn=38，哮喘n=45，COPDn=6，支气管扩张n=12）完成草案-TOPIC，其中删除了RUCC的“fit”较差的项目以创建TOPIC（8个触发项目，7个感觉项目)。RUCC（37.0）与ILD（24.5，p=0.009）和哮喘（7.0，p<0.001）相比，TOPIC评分中位数明显更高，但不是支气管扩张（20.0，p=0.318）或COPD（18.5，p=0.238），可能是由于样本量小。Rasch模型在RUCC中表现出优异的拟合(χ2=22.04,p=0.85;PSI=0.88);如预期的那样。当包括所有参与者组时，由于异质性增加（CI=0.077），不再证明拟合（χ2=66.43，p=0.0001，PSI=0.89）。TOPIC与SGRQ(r=0.47,p<0.001)和CSD(r=0.63,p<0.001)呈正相关。TOPIC（组内相关系数）的重测可靠性非常好（r=0.90，p<0.001）。
结论：RUCC患者的高TOPIC评分表明他们的咳嗽具有特定的感觉和触发因素。咳嗽诊所中TOPIC的验证可能证明其有助于识别RUCC与其他条件下咳嗽的特征。
