Cough, sputum symptoms tied to impaired quality of life: Pilot study

Researchers applied CASA-Q to 48 adults with CF

Steve Bryson, PhD avatar

by Steve Bryson, PhD |

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Cough and sputum symptoms in adults with cystic fibrosis (CF), as assessed by the Cough and Sputum Assessment Questionnaire (CASA-Q), were significantly linked to impaired quality of life, according to a pilot study.

Worse cough and sputum symptoms occurred more often in women, those with severe shortness of breath after exercise, and patients with one F508del mutation in the CFTR gene, the most common CF-causing genetic defect.

“This simple easy-to-use tool could be used in routine clinical practice and in clinical studies to assess cough and sputum in CF patients,” the researchers wrote in “Current cough and sputum assessed by the cough and sputum assessment-questionnaire (CASA-Q) is associated with quality of life impairment in cystic fibrosis,” which was published in BMC Pulmonary Medicine.

The buildup of thick and sticky mucus in the lungs is a common feature of CF. Such symptoms may lead to chronic cough, airway blockages with sputum, and recurrent lung infections.

CASA-Q is a self-administered questionnaire that assesses cough and sputum symptoms and their impact on daily activity over seven days. It was developed to evaluate these symptoms in people with chronic obstructive pulmonary disease(COPD), a chronic inflammatory disease of the lungs.

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Researchers in France applied CASA-Q to 48 adults with CF (69% men) to examine possible links with clinical characteristics and quality of life (NCT02924818). None of the patients were receiving CFTR modulator therapy.

Chronic lung infections with common CF-related bacteria were widespread among the study’s participants, including 37 (74%) with Staphylococcus aureus and 20 (40%) with Pseudomonas aeruginosa.

CASA-Q contains four domains: cough symptoms, cough impact, sputum symptoms, and sputum impact. Scores for each were added and rescaled to a score of 0 to 100, with higher scores reflecting milder lung impairment.

Cough symptoms were significantly worse in women than men (mean, 47 vs. 63), as was the impact of cough (mean, 65 vs. 83).

Severe shortness of breath with exercise was associated with worse lung impairment in all four domains: cough symptoms (39 vs. 63), cough impact (54 vs. 84), sputum symptoms (42 vs. 68 ), and sputum impact (69 vs. 90).

Exacerbations in the past year, or a sudden worsening of symptoms, were significantly associated with cough (53 vs. 68) and sputum symptom (56 vs. 76) scores compared to not having those symptoms.

Sputum impact scores were worse for CF patients who carried one copy of the CFTR F508del mutation than for those with two copies (76 vs. 93).

Lung function or abnormal features on lung CT scans were not associated with any CASA-Q domains, however.

Patients were then divided into two groups based on high or low overall CASA-Q scores. Consistently, those in the low score group, reflecting the most severely impaired patients, were more often women, those with severe shortness of breath after exercise, and patients with one CFTR F508del mutation.

Correlating quality of life scales with CASA-Q

The Cystic Fibrosis Questionnaire-Revised (CFQ-R) was applied to measure lung and digestive function and well-being during the past two weeks. Domains include physical functioning, vitality, emotion, weight, body image, eating disturbance, treatment burden, perceptions regarding role, social, and health, as well as lung and digestive symptoms. Higher scores indicate better quality of life. The Saint George Respiratory Questionnaire (SGRQ) tested the impact of lung disease on quality of life and well-being. Domains include impact, activities, and symptoms. Higher scores indicate worse quality of life. Both CFQ-R and SGFQ range from 0 to 100.

The most impaired domain on the CFQ-R was vitality (mean, 57), that is, being strong and active. The least impaired domain in CFQ-R was eating disturbances (mean, 89). With the SGRQ, results showed a predominant impairment in the symptoms domain (mean, 45).

Worse SGRQ scores, both total and across all domains (impact, activities, and symptoms), significantly correlated with worse scores on all four CASA-Q domains, “suggesting a close association between the [two] scores,” the researchers said. Likewise, all domains of the CFQ-R, except for role perception, treatment burden, and weight, significantly correlated with all or many CASA-Q domains.

Patients with low overall CASA-Q scores saw quality of life impairment in all SGRQ and CFQ-R domains.

“This pilot study supports the use of CASA-Q for cough and sputum assessment in CF adult patients in a stable state,” said the researchers, who noted larger studies are need to validate the results. CASA-Q should be assessed “during and after a pulmonary exacerbation, and before and after initiating CF therapeutic strategies,” they said.