Kelsall et al were surprised that there were no differences in Leicester Cough Questionaire (LCQ)1 scores in men and women with chronic cough and suggest that this was because the LCQ did not capture gender-specific differences in health status.2 We disagree. We have previously reported significantly worse health status in a larger group of females with chronic cough (see table 1).3 4 Furthermore, Polley et al investigated the gender differences in health status in 147 patients with chronic cough using the LCQ and another health status measure (Cough specific quality of life questionnaire) and found a clinically significant impairment in health status in females with both questionnaires.5 So why did Kelsall and colleagues not detect gender differences in health status? The lack of a significant difference in day-time cough frequency between genders may have been one factor. Health status questionnaires tend to focus more on the adverse impact of cough during the day. Interestingly, female patients in our study had significantly longer duration of cough than males; this may have contributed to the gender differences (table 1). We have previously reported a poor to moderate relationship between cough symptoms, health status, cough reflex sensitivity and cough frequency.6 Cough frequency is just one of several factors likely to be important in determining the well-being of patients. This highlights the importance of using a combination of subjective and objective tools such as automated cough monitors to assess cough severity.7

Health status questionnaires are designed to quantify quality of life numerically using the least number of questions. They are not a substitute for taking a good history. During the validation of the LCQ, health-related issues particularly pertinent to females were evaluated.1 Several items, including stress incontinence, were excluded because only a minority of patients reported them. There was also evidence that alterations in health status due to symptoms such as stress incontinence were adequately captured by items that relate particularly to the psychosocial impact. It is important to note that health status questionnaires should be designed for use in the wider population rather than targeted to a specific subset of patients.

In conclusion, the LCQ is a brief, well-validated and widely used health status questionnaire for patients with cough and can be used to detect gender differences.