Cough Severity Index (CSI)

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.
  • Theseare statements many people have used to describe their cough and the effects of their cough on their lives.
  • 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

My cough is worse when I lie down

My coughing problem causes me to restrict my personal and social life.

I tend to avoid places because of my cough problem.

I feel embarrassed because of my coughing problem.

People ask, “What’s wrong?” Because I cough a lot.

I run out of air when I cough.

My coughing problem affects my voice.

My coughing problem limits my physical activity

My coughing problem upsets me

People ask me if I am sick because I cough a lot.

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