The habit cough: Diagnosis and treatment

Weinberger, Miles

doi:10.1002/ppul.23979

Cited by 15 publications

(23 citation statements)

References 6 publications

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“…It fits an all-too-common pattern of the experiences of children and adults with chronic cough. The authors of this case expressed no knowledge of a disorder with potential relevance to their patient that was described over 300 years ago 77 and in children since then 5 , 11 , 13 , 14 . Utilizing updated information since that ancient report of “habitual cough”, we challenge the reader of this review to think about how they would have managed this lady based on current knowledge.…”

Section: Discussionmentioning

confidence: 96%

“…It is seen at major pediatric centers about 7–9 times per year 7 , 11 . Regardless of the term used, the same description occurs in repeated publications of a characteristic sound of the cough, frequently barking or honking, and the absence of the cough once asleep 5 , 8 , 9 , 11 – 14 . This is most common in children aged 8 to 13 years (mean and median, 10 years) 11 but has been seen as young as 3 and as old as 16.…”

Section: Diagnosing the Cause Of Chronic Cough In Childrenmentioning

confidence: 99%

“…The repetitive cough may be present for hours on end and even during all waking hours. While interference in getting to sleep from this cough is common, a sine qua non for the diagnosis of the habit cough is the absence of cough once asleep 14 .…”

Section: Diagnosing the Cause Of Chronic Cough In Childrenmentioning

confidence: 99%

“…The clinical presentation of habit cough, a repetitive cough absent once asleep, is sufficiently characteristic to make the diagnosis without further testing or therapeutic trials 7 , 11 . Recognizing the diagnosis then permits treatment using some form of suggestion therapy, which is generally curative 12 – 14 . Cough from asthma is readily relieved by a short course of an oral corticosteroid 22 .…”

Section: Treatment Of Chronic Cough In Childrenmentioning

confidence: 99%

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Diagnosis and management of chronic cough: similarities and differences between children and adults

Weinberger

Hurvitz

2020

F1000Res

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Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted bacterial bronchitis, tracheomalacia, habit cough, and various systemic disorders. While some diagnoses are identifiable by careful history alone, others require testing guided by specific pointers. Flexible fiberoptic bronchoscopy has been an important tool to identify etiologies of chronic cough that were not otherwise apparent. In adults, asthma and bronchitis are well-defined etiologies of chronic cough, but much chronic cough in adults is largely a conundrum. Reviews of adult chronic cough report that at least 40% of adults with chronic cough have no medical explanation. Gastroesophageal reflux and upper airway cough syndrome (a.k.a. post-nasal drip) have been common diagnoses of chronic cough, but those diagnoses have no support from controlled clinical trials and have been subjected to multiple published critiques. Cough hypersensitivity is considered to be an explanation for chronic cough in adults who have no other confirmed diagnosis. Gabapentin, a neuromodulator, has been associated with a modest effect in adults, as has speech pathology. While habit cough has not generally been a diagnosis in adults, there is evidence for a behavioral component in adults with chronic cough. Treatment for a specific diagnosis provides a better outcome than trials of cough suppression in the absence of a specific diagnosis. More data are needed for chronic cough in adults to examine the hypothesized cough hypersensitivity and behavioral management. This article reviews etiologies and the treatment of chronic cough in children and the conundrum of diagnosing and treating chronic cough in adults.

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Section: Discussionmentioning

confidence: 96%

Section: Diagnosing the Cause Of Chronic Cough In Childrenmentioning

confidence: 99%

Section: Diagnosing the Cause Of Chronic Cough In Childrenmentioning

confidence: 99%

Section: Treatment Of Chronic Cough In Childrenmentioning

confidence: 99%

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Diagnosis and management of chronic cough: similarities and differences between children and adults

Weinberger

Hurvitz

2020

F1000Res

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“…The cough subsides when the child is engrossed in an activity but becomes more evident with attention. In addition, absence of cough once asleep is considered essential in the diagnosis of habit cough [32,33]. In most children suffering from habit cough, family life and school attendance are disrupted, and a vicious circle is established.…”

Section: Introductionmentioning

confidence: 99%

Methacholine and FeNO Measurement in Patients with Habit Cough

et al. 2023

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Background Chronic cough is one of the most common symptoms in childhood. Making a definite diagnosis is a challenge for all pediatricians especially in patients when cough is without an organic cause like in habit cough. Patients and Methods In this retrospective analysis, all electronic outpatient charts of the Division of Allergology and Pneumology, between January 1, 2010 and December 31, 2019 were reviewed in order to study all children with potential habit cough. All children underwent the following diagnostic algorithms, skin prick test (SPT), measurement of fractional exhaled nitric oxide (FeNO), spirometry and methacholine challenge test (MCT). The value of a normal MCT and FeNO measurement for diagnosing habit cough was investigated. Results The chart review revealed 482 patients with chronic cough>4 weeks. Of these, 99 (20.5%) with suspected habit cough were collected. 13 patients had to be excluded for other diagnosis and a complete data set was available in 55 patients. 33 (60.0%) of 55 patients were SPT negative and 22 (40.0%) had sensitization to common allergens. Five patients had elevated FeNO≥20 ppb and three showed severe bronchial hyperresponsiveness<0.1 mg methacholine, challenging the diagnosis of habit cough. Conclusion A normal FeNO and MCT can help confirm the clinical diagnosis of habit cough. However, in patients with positive MCT and/or elevated FeNO habit cough can be present. Especially in patients with elevated FeNO and severe BHR cough variant asthma and eosinophilic bronchitis have to be ruled out.

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