How to complete this Questionnaire:
- This questionnaire is designed as an aid in the assessment of the severity and impact of your cough on your life.
- These are statements many people have used to describe their cough and the effects of their cough on their lives.
- In the last 1 month, how did the following problems affect you?
- Please circle the response that indicates how frequently you experience the same symptoms
- If you do not have a problem with coughing, please circle zero (0) in response to these statements
0 - 4 Rating Scale
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always