Richard S. Irwin’s research while affiliated with University of Massachusetts Chan Medical School and other places

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Publications (288)


Patient baseline characteristics
Development of the McMaster Cough Severity Questionnaire (MCSQ) for patients with chronic cough
  • Conference Paper
  • Full-text available

October 2024

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35 Reads

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Gordon Guyatt

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The McMaster Cough Severity Questionnaire (MCSQ): a cough severity instrument for patients with refractory chronic cough

October 2024

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22 Reads

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1 Citation

European Respiratory Journal

Background Cough severity represents an important endpoint to assess the impact of therapies for patients with refractory chronic cough (RCC). Objective To develop a new patient-reported outcome measure addressing cough severity in patients with RCC. Methods Phase 1 (item generation): A systematic survey, focus groups, and expert consultation generated 51 items. Phase 2 (item reduction): From a list of 51 items, 100 patients identified those they had experienced in the previous year and rated their importance on a 5-point scale. The MCSQ included items reported to occur most frequently and that had the highest importance scores. Patient feedback on the MCSQ led to elimination of redundant items. Another 100 patients completed the MCSQ, from which we performed an exploratory factor analysis and a Rasch analysis to further refine items on the MCSQ. Results Phase 2 led to selection of 15 items from the initial 51. Patient feedback on the 15 items led to elimination of 5 redundant items. An exploratory factor analysis of the 10-item MCSQ led to selection of two domains, elimination of one item that demonstrated cross-loading, and another that had high inter-item correlations. A Rasch analysis of the 8-item MCSQ confirmed that the response options functioned in a logically progressive manner and that no items exhibited differential item functioning. The final 8-item MCSQ has a one-week recall period and includes two domains (intensity and frequency). The 8-item MCSQ had high internal consistency (Cronbach's alpha, 0.89), proved able to distinguish different levels of cough severity (Pearson separation index, 0.89), and demonstrated high cross-sectional convergent validity (Pearson's correlation, 0.76 [95% CI 0.66 to 0.83]) with the 100-mm cough severity visual analogue scale. Conclusion Initial evidence supports the validity of the MCSQ, an 8-item instrument measuring cough severity in patients with RCC. Future studies should evaluate its properties in measuring change over time.





Managing Chronic Cough Associated with Idiopathic Pulmonary Fibrosis — Will Nalbuphine Fill an Unmet Need?

July 2023

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12 Reads

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2 Citations

NEJM Evidence

In this issue of NEJM Evidence, Maher et al.1 report the results of a randomized, controlled, 22-day treatment crossover trial comparing the antitussive effect of extended-release nalbuphine, an opioid agonist-antagonist, with placebo in a cohort of patients with definite or probable idiopathic pulmonary fibrosis (IPF). In this small, short-term trial of 38 evaluable patients, the active drug was associated with a 75.1% reduction in daytime objective cough frequency (the primary outcome) compared with a 22.6% reduction in placebo-treated patients, yielding a substantial and statistically significant 52.5 percentage point placebo-adjusted change from baseline.


Cont.
Cough Hypersensitivity Syndrome: Why Its Use Is Inappropriate in Children

July 2023

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52 Reads

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7 Citations

In children and adults, chronic cough is a common symptom presenting to health professionals worldwide. It is internationally accepted that children with chronic cough should be managed with pediatric specific management guidelines. The newly proposed clinical entity of ‘cough hypersensitivity syndrome’ has gained significant attention in adult literature. Given the significant differences between childhood and adult chronic cough, including in respiratory physiology and anatomy, and cough sensitivity, we address the suitability of the use of cough hypersensitivity syndrome in children. We explore these differences between childhood and adult chronic cough, explain what cough hypersensitivity is and highlight why the term cough hypersensitivity syndrome should not be used in children.


Yardstick for Managing Cough. Part 2: in Children

February 2023

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46 Reads

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2 Citations

Annals of Allergy Asthma & Immunology

Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to respiratory specialists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the evidence-based guidelines most of which have been developed from high quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. Chronic cough in children is often benign and self-limiting. Utilizing established and validated protocols as well as specific pointers (clues in history, findings on exam) can aid the clinician in identifying causes when present and improve outcomes. In this manuscript, Part 2 of the 2-part series, we provide evidence-based, expert opinion recommendations on the management of chronic cough in the pediatric patient (<14 years of age).


Yardstick for Managing Cough. Part 1: in Adults and Adolescent Patients >14 years of age

December 2022

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20 Reads

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6 Citations

Annals of Allergy Asthma & Immunology

Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to pulmonologists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the latest evidence-based guidelines most of which have been developed from recent high quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. In this manuscript, part 1 of the 2-part series, we provide evidence-based, and expert opinion recommendations on the management of chronic cough in adult and adolescent patients (>14 years of age).


TABLE 2 Continued
Assessing cough symptom severity in refractory or unexplained chronic cough: findings from patient focus groups and an international expert panel

March 2022

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112 Reads

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21 Citations

ERJ Open Research

Background: Cough symptom severity represents an important subjective end-point to assess the impact of therapies for patients with refractory or unexplained chronic cough (RCC/UCC). As existing instruments assessing the severity of cough are neither widely available nor tested for measurement properties, we aim to develop a new patient-reported outcome measure addressing cough severity. Objective: The aim of this study was to establish items and domains that would inform development of a new cough severity instrument. Methods: Three focus groups involving 16 adult patients with RCC/UCC provided data that we analysed using directed content analysis. Discussions led to consensus among an international panel of 15 experts on candidate items and domains to assess cough severity. Results: The patient focus group provided 48 unique items arranged under broad domains of urge-to-cough sensations and cough symptom. Feedback from expert panel members confirmed the appropriateness of items and domains, and provided an additional subdomain related to cough triggers. The final conceptual framework comprised 51 items in the following domains: urge-to-cough sensations (subdomains: frequency and intensity) and cough symptom (subdomains: triggers, control, frequency, fit/bout duration, intensity, quality and associated features/sequelae). Conclusions: Consensus findings from patients and international experts established domains of urge-to-cough and cough symptom with associated subdomains and relevant items. The results support item generation and content validity for a novel patient-reported outcome measure for use in health research and clinical practice.


Citations (66)


... The placebo alone can achieve a cough reduction of over 60%, and in cases of acute cough, this percentage can reach up to 85% 39 . The most typical example whose benefit was greatly overlapped by the placebo is gefapixant 40 . It was approved by Japan and European regulatory authorities, indicated for adults with RCC or UCC, on the evidence of both subjective and objective response. ...

Reference:

Decoding the Impact of the Placebo Response in Clinical Trials for Chronic Cough
Gefapixant for Refractory or Unexplained Chronic Cough?
  • Citing Article
  • September 2023

JAMA The Journal of the American Medical Association

... On the contrary, Chang et al. recently opposed using the term cough hypersensitivity syndrome in children. They considered it "inappropriate" because of the different nature and causes of chronic cough in children and adults [14]. ...

Cough Hypersensitivity Syndrome: Why Its Use Is Inappropriate in Children

... The common underlying etiologies of chronic cough in children are different to those in adults and thus evidence-based guidelines for adults [12,27] and children [11,31] differ in countries such as the USA. These common etiologies of chronic cough in children are dependent on the setting (country, type of clinic, sampling frame, etc.) and have been summarized in a systematic review [32]. ...

Yardstick for Managing Cough. Part 2: in Children
  • Citing Article
  • February 2023

Annals of Allergy Asthma & Immunology

... Необходимо помнить, что причины длительного, хронического кашля различны для взрослых и детей [9][10][11]. Длительный кашель у ребенка в сочетании с другими дополнительными симптомами (одышка при физической нагрузке, гнойная мокрота, рецидивирующее свистящее дыхание, дефицит массы тела, задержка роста, быстрая утомляемость, стеаторея, деформация грудной клетки) всегда является признаком развития серьезного хронического заболевания бронхолегочной системы [12][13][14]. ...

Yardstick for Managing Cough. Part 1: in Adults and Adolescent Patients >14 years of age
  • Citing Article
  • December 2022

Annals of Allergy Asthma & Immunology

... An urge to cough is present in the majority of patients with chronic cough, although it is not universal (23). This to some patients can be more bothersome than the cough itself, and have a significant impact on a patient's perception of their disease (23,24). ...

Assessing cough symptom severity in refractory or unexplained chronic cough: findings from patient focus groups and an international expert panel

ERJ Open Research

... During the last few years, objective evaluation of cough sounds, in particular evaluating its quantitative characteristics in terms of sound frequency or intensity, has gained popularity for detecting and distinguishing different respiratory dysfunctions [12,[14][15][16][17][18]. The increasing evidence concerning the objective evaluation of cough is also grounded by the physiological mechanisms of coughing which require considerable coordination and timing of breathing, thus being sensitive to abnormalities in the respiratory system [19,20]. Physiologically, cough involves a deep inspiration, followed by vigorous contraction of the expiratory muscles (in particular the abdominal muscles) against a closed glottis. ...

Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report
  • Citing Article
  • April 2021

Chest

... As a protective response for expelling harmful substances from the airway, the cough reflex is critical for human and animal survival. [1][2][3] Patients with chronic cough often exhibit cough hypersensitivity, characterized by an exaggerated cough response to relatively mild stimuli. [4][5][6] Considering the physiological functions and pathological relevance of cough, understanding the mechanisms that govern the cough reflex and its hypersensitivity is essential for advancing therapeutic strategies. ...

Global Physiology and Pathophysiology of Cough: Part 1: Cough Phenomenology – CHEST Guideline and Expert Panel Report
  • Citing Article
  • September 2020

Chest

... These results further support the important role of vagal hypersensitivity in CC. Provided the Arnold nerve is the only cutaneous peripheral branch of the vagus nerve, it has been considered a window that transmits biofeedback from its peripheral receptors to the brain (59). However, in the study conducted by Mai et al. (60) compared with 0% of healthy subjects, 73% of CC patients had positive ANR or UTC, of which 87.5% were negative after one-month treatment. ...

When Evaluating Patients With Chronic Cough, Should Clinicians Routinely Test the Arnold Nerve Reflex, Look in the Ears, or Do Both?
  • Citing Article
  • July 2020

Chest

... Chronic cough is associated with a number of secondary physical effects across multiple organ systems including sore throat, voice changes, headaches, syncope, arrhythmias, rib fractures, hernias and urinary incontinence (11,27). These can in turn lead to marked fatigue, poor sleep, and psychosocial effects (27). ...

Life-Threatening and Non-Life-Threatening Complications Associated With Coughing: A Scoping Review

Chest