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From challenge test to questionnaire: mapping cough hypersensitivity

Published online March 14, 2025

Chronic cough is increasingly recognized as a disorder of cough hypersensitivity, characterized by coughing triggered by low levels of chemical, physical and thermal stimuli. The cough challenge test, performed by inhaling a single chemical such as capsaicin, citric acid or other agents, is currently used to measure cough sensitivity. However, this method fails to capture the full spectrum of cough sensitivity related to chemical, mechanical, and thermal triggers in a patient‑friendly format. This limitation has hindered a comprehensive evaluation of cough hypersensitivity. To address this gap, the Cough Hypersensitivity Assessment Test (CHAT) was developed.

In The Journal of Allergy and Clinical Immunology: In Practice, Feng et al. report CHAT, a novel questionnaire designed to assess cough hypersensitivity in multiple dimensions. Items cover a variety of chemical (e.g., smoke, air pollutants), mechanical (e.g., talking, eating), and thermal triggers (e.g., cold air) as well as abnormal sensations in the throat that provoke coughing. As a patient‑friendly and rigorous tool, CHAT not only evaluates cough sensitivity comprehensively but also quantifies the degree of hypersensitivity, making it valuable for clinical trials and management of chronic cough.

CHAT consists of 18 items scored on a 5-point Likert scale (0-4) with a maximum score of 72, with a score ≥ 18 indicating cough hypersensitivity. The questionnaire has demonstrated excellent internal consistency (Cronbach’s α = 0.832) and test–retest reliability (ICC = 0.884). Its validity was further supported by strong, expected correlations with established cough related measures. Moreover, CHAT scores decreased significantly following effective treatment in patients with chronic cough, suggesting its utility in assessing both cough hypersensitivity and efficacy of antitussives in clinical trials.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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