Habit cough

A habit cough (also known as psychogenic cough and pseudoasthma) is a cough that may develop in children or adolescents after a cold or other airway irritant. It has also been reported in adults.[1]

Symptoms

Habit cough is characterized by a small, harsh tinny type sound, and becomes persistent for weeks to months. The cough's hallmarks are severe frequency, often a cough every 2–3 seconds, and the lack of other symptoms such as fever. The child can have trouble falling asleep but once asleep will not cough.

Diagnosis

Psychogenic cough should be considered in patients who present with a chronic cough with no obvious organic basis that has failed empirical therapy for postnasal drip, asthma, and gastroesophageal reflux.[2] It is important that the diagnoses of habit cough or psychogenic cough be made only after an extensive evaluation is made that includes ruling out tic disorders and uncommon causes of chronic cough, and when cough improves with behavior modification or psychiatric therapy.[3]

The America College of Chest Physicians gives guidelines which includes the following: In adults with chronic cough, the presence or absence of nighttime cough or cough with a barking or honking character should not be used to diagnose or exclude a diagnosis of psychogenic cough. In children with chronic cough, the characteristics of the cough may be suggestive of, but are not diagnostic of, psychogenic cough. The presence or absence of nighttime cough should not be used to diagnose or exclude psychogenic cough.[3]

Treatment

The treatment does not involve medicines. Cough medicines, even opioid ones are ineffective as are inhalers or steroids. The child will often begin to miss school and other activities due to the cough. Most of the time these children are not psychologically abnormal, but the cough can be a source of secondary gain.

Successful treatments have involved self-hypnosis, speech therapy, and a brief course of suggestion therapy outlined in the Annals of Allergy, Volume 67, December 1991, pp. 579–83 (Lokshin, MD, et al.) With suggestion therapy, the patient was given a distractor (lidocaine nebulizer) while being told by a physician (authority figure) that he/she can control the cough with this exercise, and that the cough is just vicious cycle where the initial irritant that caused the cough is gone but the urge to cough continues the irritation.

Then starting with 3 seconds the child is asked to hold the cough for that amount of time. After success the amount of time the child is asked to hold his breath is increased to 5 seconds, 10 seconds, etc. up to 60 seconds. When the child gets to 60 seconds usually the desire to cough is gone and the child congratulated on controlling the cough. Follow-up sessions can be done at home with the parent using chloroseptic spray as the distractor. In the study in the Annals of Allergy, some children who coughed for months were stopped in one session. If short therapy does not work refer the child to a psychologist.

See also

References

  1. ↑ Goldsobel AB, Chipps BE (March 2010). "Cough in the pediatric population". J. Pediatr. 156 (3): 352–358.e1. doi:10.1016/j.jpeds.2009.12.004. PMID 20176183.
  2. ↑ https://www.ncbi.nlm.nih.gov/pubmed/11894731
  3. 1 2 http://journal.publications.chestnet.org/pdfaccess.ashx?ResourceID=2118484&PDFSource=13
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