When is cough functional, and how should it be treated?

Abstract

Key pointsHabit cough is most commonly characterised by a repetitive loud barking cough that persists for prolonged periods.The cough interferes with normal activity and substantially decreases the quality of life.The sine qua non is the total absence of this troublesome cough once asleep.The age distribution ranges from 4 years to late adolescence, with 85% of cases occurring from 8 to 14 years of age; similar cough in adults is much less common and poorly characterised.Pharmacological treatment is ineffective.A simple behavioural approach called suggestion therapy has been applied with success by many physicians.The natural history in the absence of treatment can result in persistence for months to years.Educational aimsTo increase awareness of functional cough as a non-organically caused symptom in children and adolescents.To provide the means of diagnosing a functional cough based on the distinguishing characteristics of this cause of chronic cough.To understand the principles of treating a functional cough with a simple behavioural technique called suggestion therapy.SummaryInvoluntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience in children and adolescents suggests that “habit cough” best describes this entity, and suggestion therapy is a highly effective treatment that most physicians can learn.

Habit‐tic cough: Presentation and outcome with simple reassurance

“…Absence refers to absence of the loud persistent daytime cough; it does not mean complete absence of any cough at night, as the occasional cough can be normal, especially during viral colds. This was the case in 93% of the children reported at the initial consultation (similar to other series), and we would not make the diagnosis if the child persistently coughed throughout the night. When the parents thought the child might have a nocturnal cough they were asked to check that the child was truly asleep when coughing, rather than awake and coughing before falling asleep again.…”

Pertussis Reinfection in an Adult: A Cause of Persistent Cough Not to Be Ignored

“…Coinfections, particularly with Bordetella pertussis and RSV, are commonly seen among infants [13]. In adult patients, it is essential that the differential diagnosis of persistent cough should include primary and secondary pulmonary malignancies, and imaging with X-ray or Computed Tomography (CT) of the chest must be accordingly performed in these cases [21]. …”

The habit cough: Diagnosis and treatment

“…Cessation of cough was accomplished with suggestion therapy by the attending clinician in all but three patients. Details of the treatment failures are described in a subsequent review of the subject . Fifty‐five patients seen during the 20‐year period had a convincing history of active habit cough but were not coughing during the clinic visit.…”

“…Details of the treatment failures are described in a subsequent review of the subject. 6 Fifty-five patients seen during the 20-year period had a convincing history of active habit cough but were not coughing during the clinic visit. Where cough was not present when seen in the clinic, autosuggestion, the same principle as our suggestion therapy was taught so that the child could prevent any return of cough from again becoming chronic (Table 1).…”