OBJECTIVES: Prior to use in an international study, the Asthma Symptom Diary and Kidney Disease and Quality of Life underwent linguistic validation into over 30 languages.  This involved linguistic validation work on common languages targeted for different countries via the forward / backward translations or adaptation steps and cognitive debriefing step. This study aims to investigate similarities and differences in the translation of key terms and wordings and determine potential patterns across groups of languages. METHODS: This investigation was carried out as follows: (1) Identification of key terms and words (2) Collation and comparison of the translations across the same language versions (3) Identification of similarities and differences (4) Review of discussions and issues from the translation process. RESULTS: The linguistic validation process was shown to be able to identify and resolve important cross-cultural differences.  Key findings included the identification of potential recurring translation issues between same language groups.  Within the German, French and Spanish languages, technical terminology was translated alike whilst there were differences in the way non-technical, socially constructed wordings, emotions and symptoms were translated due to such factors as idiomatic formulations and cultural differences.  Across the English languages, the text was simplified or elaborated as part of the adaptation process.  Across the Russian and Chinese languages there were differences in the way technical and disease-specific terms were translated. CONCLUSIONS: With the insight of the linguistic validation process, important differences were identified and resolved between technical terms and general wordings across same language groups.  Cognitive debriefing is highly recommended and this will ensure appropriate comprehension across cultures and facilitate International comparison and pooling of data.