{ "abstract": "Background\n\nRespiratory symptoms are common among smokers without COPD, yet symptom instruments are often optimized for established disease and may under-capture early changes relevant to cessation and tobacco harm reduction. We conducted a repeatability and replicability study of the Respiratory Symptom Experience Scale (RSES) in a rigorously phenotyped cohort to confirm both measurement stability and reproducible discrimination by smoking status.Methods\n\nHealthy adults were recruited at a UK hospital and classified as current, former, or never smokers using self-report, exhaled CO, and a comprehensive panel of biomarkers of exposure. RSES was administered at Visit 1 and repeated after 7 ± 3 days at Visit 2 to assess test-retest repeatability. Known-group validity (discriminability by smoking status) was evaluated by comparing RSES scores across biochemically verified groups using non-parametric tests, with ANCOVA for exploratory covariate adjustment. True replicability across independent datasets was not formally tested in the present study.Results\n\nOf 180 enrolled participants, 170 were included (55 current smokers, 60 former smokers, 55 never smokers) after excluding clinical ineligibility and biomarker-inconsistent smoking status. RSES demonstrated high repeatability (Pearson r = 0.87; Spearman ρ = 0.85) with minimal bias (- 0.07) and good agreement. RSES also showed consistent known-group discrimination by smoking status, differing between current and never smokers (p < 0.0001) and across all three groups (p < 0.0001). Current smokers reported higher scores than never (median 2.0 vs. 1.0) and former smokers (2.0 vs. 1.2), whereas former and never smokers did not differ (p = 0.686). Covariate adjustment did not materially alter results.Conclusions\n\nRSES shows strong repeatability and consistent known-group discrimination by smoking status, supporting its use as a patient-relevant endpoint for cessation, and harm-reduction trials, as well as for clinical respiratory and regulatory research.", "abstract_shown": true, "affiliations": [ "Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy. pasquale.caponnetto@unict.it.", "Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy. pasquale.caponnetto@unict.it.", "Psychiatry Unit, University Teaching Hospital \"Policlinico-S.Marco\", University of Catania, Catania, Italy. pasquale.caponnetto@unict.it.", "Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy.", "Respiratory Unit, University Teaching Hospital \"Policlinico-S.Marco\", University of Catania, Catania, Italy.", "JB Medical, London, UK.", "Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.", "Emergency Department, University Teaching Hospital \"Policlinico-S.Marco\", University of Catania, Catania, Italy.", "Ashford & St.Peters Hospital, NHS Trust, Chertsey, UK.", "Metanoic Health Ltd, Worcester Park, Surrey, UK.", "KAM School of Life Sciences, Forman Christian College (A chartered University), Lahore, Pakistan.", "ECLAT Srl, Spin-off of the University of Catania, Catania, Italy.", "Faculty of Medicine and Surgery, \"Kore\" University of Enna, Enna, Italy.", "ABF Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany.", "Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital \"Policlinico-S.Marco\", University of Catania, Catania, Italy." ], "article_type": "research article", "arxiv": null, "author_total": 12, "authors": [ { "affs": [ 0, 1, 2 ], "name": "Pasquale Caponnetto" }, { "affs": [ 3, 4 ], "name": "Lucia Spicuzza" }, { "affs": [ 3, 4 ], "name": "Domenico Caratozzolo" }, { "affs": [ 5 ], "name": "Jonathan Belsey" }, { "affs": [ 6, 4, 7 ], "name": "Davide Campagna" }, { "affs": [ 8 ], "name": "Meera Nadir" }, { "affs": [ 8, 9, 10 ], "name": "Isaac John" }, { "affs": [ 11 ], "name": "Erika Anastasi" }, { "affs": [ 12 ], "name": "Giulio Geraci" }, { "affs": [ 13 ], "name": "Nikola Pluym" }, { "affs": [ 13 ], "name": "Max Scherer" }, { "affs": [ 6, 3, 14 ], "name": "Riccardo Polosa" } ], "bibtex": "https://research.draconitic.com/paper/6rtwmyg5fe823.bib", "cited_by": 0, "doi": "10.1186/s12955-026-02591-z", "fulltext_url": "https://europepmc.org/articles/PMC13689366", "id": "6rtwmyg5fe823", "issns": [ "1477-7525" ], "landing_url": "https://europepmc.org/article/MED/42907865", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "lcc", "R858-859.7" ], [ "openalex", "2737|Smoking Behavior and Cessation" ] ], "openalex": "W7170609561", "pdf_url": "https://europepmc.org/articles/PMC13689366?pdf=render", "pmcid": "PMC13689366", "pmid": "42907865", "published": "2026-07-01", "publisher": "BMC", "ris": "https://research.draconitic.com/paper/6rtwmyg5fe823.ris", "sources": [ { "first_seen": "2026-10-30T12:19:59Z", "native_id": "MED:42907865", "source": "europepmc", "url": "https://europepmc.org/article/MED/42907865" }, { "first_seen": "2026-10-30T13:46:20Z", "native_id": "39174c6e48f3423ab03734d218ab0adf", "source": "doaj", "url": "https://doi.org/10.1186/s12955-026-02591-z" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2737|Smoking Behavior and Cessation", "subfield": "physiology" } ], "title": "Repeatability and replicability of the Respiratory Symptom Experience Scale (RSES): internal and external validation of smoking-status differences in respiratory symptoms.", "title_text": "Repeatability and replicability of the Respiratory Symptom Experience Scale (RSES): internal and external validation of smoking-status differences in respiratory symptoms.", "type": "peer-reviewed", "updated_at": "2026-10-30T13:46:20Z", "url": "https://research.draconitic.com/paper/6rtwmyg5fe823", "venue": "Health and quality of life outcomes", "versions": [] }