Wisconsin Upper Respiratory Symptom Survey (WURSS)

The Wisconsin Upper Respiratory Symptom Survey (WURSS) is an evaluative illness-specific quality of life instrument, designed to assess the negative impact of acute upper respiratory infection, presumed viral (the common cold).  Long (WURSS-44) and short (WURSS-21) versions have been validated.  The WURSS-21 has been translated into Spanish, Japanese, French, German, Korean, Russian, and Ukranian.  Influenza-like illness symptoms of headache, body aches and fever are included on the WURSS-24.

Acute respiratory infection (ARI), including the common cold and influenza, is the most prevalent of human illnesses. Surveys report that over 70% of people experience at least one cold in a given year, with adults averaging 2 or 3 colds and young children averaging as many as 4 to 6 colds per year. More than 45 million days of work and 22 million days of school are lost as a result. In the U.S. alone, more than $2 billion is spent out of pocket annually on cold remedies, with more than $7 billion in sick pay losses attributable to non-influenza ARI.  One study estimated annual direct costs at $17 billion and indirect costs at $22.5 billion, for a total economic impact of close to $40 billion. ARI is the most important cause of asthma exacerbation, and often leads to otitis media, sinusitis, bronchitis or pneumonia. For those at increased risk, such as the very old, those with multiple illnesses, or the immune compromised, ARI may be fatal.

Despite the fact that more than 300 randomized controlled trials have spent millions of dollars testing dozens of cold remedies, prior to WURSS there was no well-developed, standardized and validated measure for assessing the symptomatic and functional impact of ARI.

In order to develop and validate such an instrument, we chose to combine qualitative and quantitative methodologies, including cognitive interview and focus group. A published description of the development process is available:

B. Barrett, K. Locken, R. Maberry, J. Schwamman, J. Bobula, R. Brown, and E. Stauffacher. The Wisconsin Upper Respiratory Symptom Survey: Development of an instrument to measure the common cold. Journal of Family Practice 51(3):265-www.jfponline.com, 2002

We then went on to prospectively validate the WURSS-44, aiming for assessment of reliability, responsiveness, importance-to-patients, and convergent validity. Over 18 months some 149 people with colds filled out the WURSS-44, the Jackson scale and the SF-8 (24-hour recall version) each day from the beginning of their colds until their symptoms had resolved, generating a data set of 1,681 person-days. Using importance-to-patient and responsiveness as guides, a subset of items was selected for the WURSS-21..

Validation of the WURSS-44 and derivation of the WURSS-21 are described in:

B. Barrett, R. L. Brown, M. P. Mundt, N. Safdar, L. Dye, R. Maberry, and J. Alt. The Wisconsin Upper Respiratory Symptom Survey is responsive, reliable, and valid. Journal of Clinical Epidemiology. 58 (6):609-617, 2005.

A third paper comparing WURSS with laboratory-based measures was published next. Using data from an NIH-funded randomized controlled trial in an induced cold experimental rhinovirus infection model, this paper compares WURSS scores with quantitative viral culture, nasal mucus weight, neutrophil count, interleukin-8 and glutathione, and with the self-report questionnaire scores from the Jackson cold scale and the SF-8 general health-related quality-of-life instrument.

B. Barrett, R. Brown, R. Voland, R. Maberry, and R. Turner. Relations among questionnaire and laboratory measures of rhinovirus infection. European Respiratory Journal 28 (2):358-363, 2006.

A fourth manuscript detailing anchor-based and distribution-based methods of assessing important difference and responsiveness was next made available:

B. Barrett, R. Brown, and M. Mundt. Comparison of anchor-based and distributional approaches in estimating important difference in common cold. Qual.Life Res. 17 (1):75-85, 2008.

More recently, we completed a prospective independent evaluation of the WURSS-21 compared to the WURSS-44 and several other measures. This study included 230 participants who were monitored for 2,457 person-days. See:

B. Barrett, R. E. Brown, M. P. Mundt, G. R. Thomas, S. K. Barlow, A. D. Highstrom, and M. Bahrainian. Validation of a short form Wisconsin Upper Respiratory Symptom Survey (WURSS-21). Health and Quality of Life Outcomes 7 (76), 2009.

We have used the WURSS-21 as the primary outcome measure in two NIH-funded clinical trials:

B. Barrett, R. Brown, D. Rakel, M. Mundt, K. Bone, S. Barlow, and T. Ewers. Echinacea for treating the common cold: a randomized trial.Ann.Intern.Med. 153 (12):769-777, 2010.

B. Barrett, R. L. Brown, D. P. Rakel, D. Rabago, L. Marchand, J. Scheder, M. Mundt, G. Thomas, and S. Barlow. Placebo effects in common cold: A randomized controlled trial.Annals of Family Medicine 9 (4):312-322, 2011.

B. Barrett, M. S. Hayney, D. Muller, D. P. Rakel, A. Ward, C. Obasi, R. Brown, Z. Zhang, A. Zgierska, J. E. Gern, R. West, T. Ewers, S. Barlow, M. Gassman, and C. Coe. Meditation or exercise for preventing acute respiratory infection: A randomized controlled trial.Annals of Family Medicine In press, 2012.

Who Uses WURSS?

We’re not the only ones to use WURSS.  Numerous investigators from around the world have selected WURSS for their research and/or education work.  The list of registered WURSS users represents 150 institutions in some 35 countries.

Here are cites to a few published articles describing research using WURSS:

L. Spence, W. J. Brown, D. B. Pyne, M. D. Nissen, T. P. Sloots, J. G. McCormack, A. S. Locke, and P. A. Fricker. Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes.Med.Sci.Sports Exerc. 39 (4):577-586, 2007.

M. J. Walter, M. Castro, S. J. Kunselman, et al.. Predicting worsening asthma control following the common cold.Eur.Respir.J. 32 (6):1548-1554, 2008.

S. A. Heinz, D. A. Henson, M. D. Austin, F. Jin, and D. C. Nieman. Quercetin supplementation and upper respiratory tract infection: A randomized community clinical trial.Pharmacol.Res. 62 (3):237-242, 2010.

D. C. Nieman, D. A. Henson, M. D. Austin, and W. Sha. Upper respiratory tract infection is reduced in physically fit and active adults.Br.J.Sports Med., 2010.

J. S. Byun, S. Y. Yang, I. C. Jeong, K. E. Hong, W. Kang, Y. Yeo, and Y. C. Park. Effects of So-cheong-ryong-tang and Yeon-gyo-pae-dok-san on the common cold: randomized, double blind, placebo controlled trial.J.Ethnopharmacol. 133 (2):642-646, 2011.

S. Y. Yang, W. Kang, Y. Yeo, and Y. C. Park. Reliability and validity of Wisconsin Upper Respiratory Symptom Survey, Korean version.J.Epidemiol. 21 (5):313-318, 2011.

Advice For Users

We Want to Hear From You

Educational and non-profit use is free, but must be registered. License fees for commercial use of WURSS for testing any intervention with potential for-profit application must be negotiated with Dr Barrett and/or the Wisconsin Alumni Research Foundation.