The severity of the neurological deficit was evaluated by the revised ALS Functional Rating Scale (ALS-FRS-R), which rates the ability to perform activities of daily living from 0 (total inability) to 48 points (no limitation) and incorporates respiratory items (dyspnea, orthopnea, respiratory insufficiency).
Quantitative testing (N = 311) showed two symptom factors, systemic (7 items) and respiratory (3 items), with internal consistency reliability (Cronbach's alpha) levels of 0.85 and 0.48, respectively.
The 11 respiratory symptom items, referred to as the E-RS:COPD scale, can also be scored separately to evaluate symptom outcomes in clinical trials; it includes overall symptoms, as well as specific domains assessing breathlessness, cough and sputum, and chest symptoms [11, 12].
We incorporated respiratory health items from a standardized questionnaire (ATS-DLD-78-C) translated into Chinese for a previous study in Wuhan and other Chinese cities [ 16].
In a second step, to improve these performances, we added the item "respiratory rate".
Clinical sepsis is defined as an infant with an unwell appearance, with alteration of the paediatric assessment triangle (appearance, respiratory and circulatory items).
The CASIS differs from more generic sleep measures because it was developed by focusing on the experience of patients with either asthma or COPD, excludes content targeted to generic sleep deprivation (e.g., bad dreams, get up to use bathroom, etc), and includes respiratory specific sleep items (e.g., wake up at night with breathing problems, etc).
For example, the SGRQ was developed for patients with chronic obstructive airways disease and, thus, has a limited number of respiratory symptoms, no items relevant to ear, nose and throat disease or fertility problems, long and variable recall periods and considerable respondent burden (e.g. nearly an hour to complete).
The questionnaire, which included items about respiratory symptoms, atopy, and smoking was answered by 11,463 (72%%).
13 This questionnaire includes items on respiratory symptoms such as chest tightness, shortness of breath, wheezing, cough and phlegm during the past 12 months.
