Repeatability and replicability of the Respiratory Symptom Experience Scale (RSES): internal and external validation of smoking-status differences in respiratory symptoms.
15 affiliations
- 1Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy. [email protected].
- 2Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy. [email protected].
- 3Psychiatry Unit, University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy. [email protected].
- 4Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy.
- 5Respiratory Unit, University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy.
- 6JB Medical, London, UK.
- 7Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.
- 8Emergency Department, University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy.
- 9Ashford & St.Peters Hospital, NHS Trust, Chertsey, UK.
- 10Metanoic Health Ltd, Worcester Park, Surrey, UK.
- 11KAM School of Life Sciences, Forman Christian College (A chartered University), Lahore, Pakistan.
- 12ECLAT Srl, Spin-off of the University of Catania, Catania, Italy.
- 13Faculty of Medicine and Surgery, "Kore" University of Enna, Enna, Italy.
- 14ABF Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany.
- 15Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy.
Abstract
Background
Respiratory 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
Healthy 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
Of 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
RSES 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.
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BibTeX
@article{caponnetto2026repeatability,
title = {{Repeatability and replicability of the Respiratory Symptom Experience Scale (RSES): internal and external validation of smoking-status differences in respiratory symptoms.}},
author = {Pasquale Caponnetto and Lucia Spicuzza and Domenico Caratozzolo and Jonathan Belsey and Davide Campagna and Meera Nadir and Isaac John and Erika Anastasi and Giulio Geraci and Nikola Pluym and Max Scherer and Riccardo Polosa},
journal = {Health and quality of life outcomes},
year = {2026},
month = jul,
doi = {10.1186/s12955-026-02591-z},
url = {https://europepmc.org/article/MED/42907865},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Repeatability and replicability of the Respiratory Symptom Experience Scale (RSES): internal and external validation of smoking-status differences in respiratory symptoms.
AU - Pasquale Caponnetto
AU - Lucia Spicuzza
AU - Domenico Caratozzolo
AU - Jonathan Belsey
AU - Davide Campagna
AU - Meera Nadir
AU - Isaac John
AU - Erika Anastasi
AU - Giulio Geraci
AU - Nikola Pluym
AU - Max Scherer
AU - Riccardo Polosa
PY - 2026
DA - 2026/07/01
JO - Health and quality of life outcomes
DO - 10.1186/s12955-026-02591-z
UR - https://europepmc.org/article/MED/42907865
AB - Background Respiratory 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 Healthy 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 Of 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 RSES 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.
SN - 1477-7525
ER -