University of Wisconsin–Madison
The Graduation Bucky statue is pictured wearing a face mask in the rotunda of Bascom Hall at the University of Wisconsin-Madison on Nov. 21, 2020. The replica of UW-Madison mascot Bucky Badger was practicing physical distancing as the global coronavirus (COVID-19) pandemic continues. (Photo by Jeff Miller / UW-Madison)

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. An even shorter version (WURSS-11) is available. Influenza-like illness symptoms of headache, body aches, and fever are included on the WURSS-24. The newest in our line of self-report instruments is the WURSS for Kids (WURSS-K), which is currently being assessed for psychometric properties.

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 the Wisconsin Alumni Research Foundation. 

WURSS Use Forms

Assessing the Impact of Acute Respiratory Infection

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 each year, with adults averaging two or three colds and young children averaging as many as four to six 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. ARI may be fatal for those at increased risk, such as the very old, those with multiple illnesses, or the immunocompromised.

Despite the fact that more than a thousand randomized controlled trials have spent many 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.

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  • Barrett B, Locken K, Maberry R, Schwamman J, Bobula J, Brown R, Stauffacher E. The Wisconsin Upper Respiratory Symptom Survey: development of an instrument to measure the common cold. J Fam Pract. 2002;51(3):265. 
  • Barrett B, Brown R, Voland R, Maberry R, Turner R. Relations among questionnaire and laboratory measures of rhinovirus infection. Eur Respir J. 2006;28(2):358-363. 
  • Barrett B, Brown R, Mundt M. Comparison of anchor-based and distributional approaches in estimating important difference in common cold. Qual Life Res. 2008;17(1):75-85. 
  • Barrett B, Brown RE, Mundt MP, Thomas GR, Barlow SK, Highstrom AD, Bahrainian M. Validation of a short form Wisconsin Upper Respiratory Symptom Survey (WURSS-21). Health Qual Life Outcomes. 2009;7:76. 
  • Obasi CN, Brown RL, Barrett BP. Item reduction of the Wisconsin Upper Respiratory Symptom Survey (WURSS-21) leads to the WURSS-11. Qual Life Res. 2013. 
  • Longmier E, Barrett B, Brown R. Can patients or clinicians predict the severity or duration of an acute upper respiratory infection? Fam Pract. 2013;30(4):379-385. 
  • Henriquez KM, Hayney MS, Xie Y, Zhang Z, Barrett B. Association of interleukin-8 and neutrophils with nasal symptom severity during acute respiratory infection. J Med Virol. 2015;87(2):330-337. 
  • Brown RL, Obasi CN, Barrett BP. Rasch analysis of the WURSS-21: dimensional validation and assessment of invariance. J Lung Pulm Respir Res. 2016;3(2). 
  • Schmit KM, Brown R, Hayer S, Checovich MM, Gern JE, Wald ER, Barrett B. Wisconsin Upper Respiratory Symptom Survey for Kids: validation of an illness-specific quality of life instrument. Pediatr Res. Published online February 24, 2021. 

We have used the WURSS-21 as the primary outcome measure in three NIH-funded randomized clinical trials.  

  • Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, Ewers T. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. 2010;153(12):769-777. 
  • Barrett B, Brown RL, Rakel DP, Rabago D, Marchand L, Scheder J, Mundt M, Thomas G, Barlow S. Placebo effects in the common cold: a randomized controlled trial. Ann Fam Med. 2011;9(4):312-322.
  • Barrett B, Hayney MS, Muller D, Rakel D, Ward A, Obasi CN, Brown R, Zhang Z, Zgierska A, Gern J, West R, Ewers T, Barlow S, Gassman M, Coe CL. Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. Ann Fam Med. 2012;10(4):337-346. 
  • Hayney MS, Coe CL, Muller D, Obasi CN, Ewers T, Barrett B. Age and psychological influences on immune responses to trivalent inactivated influenza vaccine in the Meditation or Exercise for Preventing Acute Respiratory Infection (MEPARI) trial. Hum Vaccin Immunother. 2014;10(1). 
  • Rakel D, Mundt M, Ewers T, Fortney L, Zgierska A, Gassman M, Barrett B. Value associated with mindfulness meditation and moderate exercise intervention in acute respiratory infection: the MEPARI study. Fam Pract. 2013. 
  • Obasi CN, Barrett B, Brown R, Vrtis R, Barlow S, Muller D, Gern J. Detection of viral and bacterial pathogens in acute respiratory infections. J Infect. 2014;68:125-130.
  • Obasi C, Brown R, Ewers T, Barlow S, Gassman M, Zgierska A, Coe C, Barrett B. Advantage of meditation over exercise in reducing cold and flu illness is explained by improved function and quality of life. Influenza Other Respir Viruses. 2013. 
  • Zgierska A, Obasi C, Brown R, Ewers T, Muller D, Gassman M, Barlow S, Barrett B. Randomized controlled trial of mindfulness meditation and exercise for the prevention of acute respiratory infection: possible mechanisms of action. Evid Based Complement Alternat Med. 2013. 
  • Barrett B, Hayney MS, Muller D, et al. Meditation or exercise for preventing acute respiratory infection (MEPARI-2): a randomized controlled trial. PLoS One. 2018;13(6):e0197778. 
  • Barrett B, Harden CM, Brown RL, et al. Mindfulness meditation and exercise both improve sleep quality: secondary analysis of a randomized controlled trial of community-dwelling adults. Sleep Health. 2020. 
  • Meyer JD, Hayney MS, Coe CL, et al. Differential reduction of IP-10 and C-reactive protein via aerobic exercise or mindfulness-based stress reduction training in a large randomized controlled trial. J Sport Exerc Psychol. 2019;41(2):96-106.
  • Goldstein E, Topitzes J, Brown RL, et al. Mediational pathways of meditation and exercise on mental health and perceived stress: a randomized controlled trial. J Health Psychol. 2018:1359105318772608.
  • Meyer JD, Torres ER, Grabow ML, et al. Benefits of 8-week mindfulness-based stress reduction or aerobic training on seasonal declines in physical activity. Med Sci Sports Exerc. 2018;50(9):1850-1858.  

Advice For Users

There are no perfect definitions of “common cold,” “upper respiratory tract infection,” “acute respiratory infection,” “influenza-like illness,” or similar terms; however, researchers need definitions to implement protocols.  We have found the following to be useful.

The beginning of each common cold acute respiratory infection illness episode is defined by:

  1. Answering “yes” to either “Do you think you have a cold?” or “Do you think you are coming down with a cold?” AND
  2. Reporting at least one of the following cold symptoms: nasal discharge (runny nose), nasal obstruction (plugged or congested), sneezing, or sore (scratchy) throat, AND
  3. Scoring at least 2 points on the Jackson scale. The Jackson score is calculated by summing eight symptom scores (sneezing, headache, malaise, chilliness, nasal discharge, nasal obstruction, sore throat and cough), rated as 0 (absent), 1 (mild), 2 (moderate), and 3 (severe). 

For these symptoms to be classified as an ARI illness episode (and analyzed as such), the criteria must be met for at least two days in a row.

From the first day of ARI illness and forward, participants complete the WURSS daily until they answer “no” to the question “Do you think that you are still sick with this respiratory infection?” for two consecutive days.  The last day the participant answers “yes” and fills out a WURSS instrument is classified as the last day of ARI illness.

Daily WURSS summary scores are calculated by summing individual item scores, excluding the first and last items, which assess different reference domains and are analyzed separately. 

Summary scores of ARI illness episodes are calculated by summing daily scores, using trapezoidal approximation, or by other methods as advised by the study statistician. Imputation of missing data may be useful. Data from individual items or groups of items can be analyzed separately, depending on research questions. Each study has its own aims and methods, and adjustment of the Jackson criteria threshold for defining ARI illness may be advisable. Excluding allergy and other illnesses with cold-like symptoms is usually recommended. Involvement of an experienced multidisciplinary team and rigorous peer review is strongly advised.

WURSS Recommendation

For investigators who want to assess influenza, influenza-like illness, or COVID-19, we recommend WURSS-24. It is identical to the WURSS-21, but adds items assessing headache, body aches, and fever.

Who Uses WURSS?

Numerous investigators from around the world have selected WURSS for their research and education work. The list of registered WURSS users represents more than 500 institutions in more than 50 countries.

  • Alsaleh S, Alhussien A, Alyamani A, et al. Efficacy of povidone-iodine nasal rinse and mouth wash in COVID-19 management: a prospective, randomized pilot clinical trial (povidone-iodine in COVID-19 management). BMC Infect Dis. 2024;24(1):271. 
  • Esakki A, Ramadoss R, Ananthapadmanabhan L, et al. Quantification of the anti-diabetic effect of Allium cepa. Cureus. 2024;16(4). 
  • Haas M, Brandl B, Schinhammer L, Skurk T. Individualized supplementation of immunoactive micronutrients and severity of upper respiratory infection symptoms: a randomized intervention study. Nutrients. 2024;16(10):1400. 
  • Hagen M, Clark K, Kalita P, et al. A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold. Ther Adv Respir Dis. 2024;18:17534666241228927. 
  • Lee SK, Lee DR, Kim HL, Choi BK, Kwon KB. A randomized, double-blind, placebo-controlled study on immune improvement effects of ethanolic extract of Echinacea purpurea (L.) Moench in Korean adults. Phytother Res. 2024. 
  • Michalsen A, Goldenstein K, Kardos P, et al. The impact of cineole treatment timing on common cold duration and symptoms: non-randomized exploratory clinical trial. PLoS One. 2024;19(1):e0296482.

Please let us know of the results of your WURSS-related work and alert us to any relevant publications.

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Overview

WURSS-21 was developed in English and has been adapted/translated into Bulgarian, Chinese (Mandarin), Czech, Dutch, French, French Canadian, Georgian, German, Hindi, Italian, Japanese, Korean, Maratha, Portuguese, Polish, Romanian, Russian, Spanish, and Ukrainian.

There is no cost for non-profit or educational use. However, you must notify us of such use and agree to the conditions on the linked clickwrap agreement. Pharmaceutical companies or other for-profit interests must contact us prior to any use.

Contact Us

Bruce Barrett, MD, PhD
Principal Investigator
bruce.barrett@fammed.wisc.edu
Phone: 608-263-2220
Fax: 608-263-5813

OR

Email WARF at janderson@warf.org

We welcome your comments, critiques, or suggestions.

WURSS Use Forms