Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough

Abstract

BackgroundBehavioral cough suppression therapy (BCST) with a speech–language pathologist is a common treatment for chronic nonspecific cough (a.k.a., tic cough) in children. Yet, the outcomes and duration of pediatric BCST have eluded formal investigation. This study examined whether BCST improves cough in children with nonspecific cough and factors that predict the course of treatment. Additionally, the cough characteristics and comorbidities associated with the condition were examined.MethodsA retrospective, observational cohort design was utilized. Cough characteristics, medical history, and BCST treatment details and outcomes for 151 children were extracted from the electronic medical record of a large outpatient pediatric otolaryngology clinic.ResultsCough was dry and onset unaccompanied by illness in most cases. Roughly half of patients reported gradual onset and cough proceeded by tickle. On average, patients experienced symptoms for 19 months (SD = 20.09) before diagnosis. Rates of comorbid General Anxiety Disorder were elevated compared to pediatric norms. Additionally, high rates of asthma (22.1%), reflux (62.3%), and disordered sleep breathing (19.2%) were observed. Common findings on laryngoscopy included interarytenoid edema and erythema. Vocal fold changes were observed in 22.9% of children. BCST reduced cough in 92.5% of patients following an average of 1.7 sessions. Comorbid behavioral health diagnoses (p = 0.013) or induced laryngeal obstruction symptoms (p = 0.025) were significant predictors of increased therapy sessions. Cough proceeded by tickle significantly predicted fewer sessions in therapy (p = 0.011).InterpretationAlthough randomized clinical trials are needed, these data suggest that BCST is a low‐risk, effective treatment for children with nonspecific cough.

Voice Disorder Prevalence and Vocal Health Characteristics in Children

“…56 Coughing, throat clearing, and tantrum throwing were also associated with voice problems, possibly because these behaviors involve high-impact laryngeal oscillation. 57 Research suggests that as many as 22% of children with chronic cough present with dysphonia. 58 Additionally, children involved in online gaming were 56% more likely to present with voice problems.…”

Commentary addressing concerns raised by Dr. Slovarp and her colleagues

“…Fujiki and colleagues into perspective. 3 Dr. Fujiki and colleagues retrospectively examined children with no identified cause for chronic cough at an otolaryngology clinic between 2010 and 2022.…”

“…In considering the benefit provided by Dr. Fukiki, 3 it is important to be aware of the previous 58-year history of successful identification and cure of habit cough. In 1966, an astute allergist described six children seen in his practice over a 5-year period with chronic cough inconsistent with known organic causes of cough.…”

The Habit Cough Syndrome

“…Dr. Ribert Fujiki, 1 his speech and language colleagues, and a psychiatrist, have provided unique data regarding a chronic cough in children that they identify as a "behavioral cough." Their retrospective review of 12 years of experience at an otolaryngology clinic for children referred with chronic cough provided considerable details of the patients and response to speech and language therapy.…”

“…The publication by Fujiki 1 and colleagues utilizes the skills of speech and language professionals (SLP) that provide a "reduction of cough symptoms." Clinicians with access to skilled SLP will have an option to personally provided suggestion therapy.…”