Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children

doi:10.1378/chest.15-0423

Chest

Volume 148, Issue 1, July 2015, Pages 24-31

, , , , , , , , , , , , , , , , , , , …

https://doi.org/10.1378/chest.15-0423 Get rights and content

BACKGROUND

We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic.

METHODS

We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology.

RESULTS

The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate.

CONCLUSIONS

Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.

Section snippets

Summary of Recommendations/Suggestions

1.
In adults or children with chronic cough, we suggest that the presence or absence of night time cough or cough with a barking or honking character should not be used to diagnose or exclude psychogenic or habit cough (Grade 2C).
2.
In adults with a persistently troublesome chronic cough, we suggest that the presence of depression and/or anxiety not be used as diagnostic criteria for psychogenic cough because patients with a persistently troublesome chronic cough can develop these psychologic

Materials and Methods

The methodology used by the CHEST Guideline Oversight Committee to select the Expert Cough Panel Chair and the international panel of experts, perform the synthesis of the evidence, and develop the recommendations and suggestions has been published.3, 4 Key questions and parameters of eligibility were developed for this topic. Existing guidelines, systematic reviews, and primary studies were assessed for relevance and quality and were used to support the evidence-based graded recommendations or

Results

The recommendations and/or suggestions that follow are based upon a recently published systematic review² that included the comprehensive search of multiple databases without language restriction. The review identified a total of 18 uncontrolled studies that had enrolled 223 patients, 96% consisting of children or adolescents, 54% of whom were female.

Conclusions

Since publication of the 2006 CHEST Cough Guidelines,¹ the field of psychogenic, habit, and tic cough has advanced based upon the results of the recent systematic review on the topic.² Compared with the 2006 publication, the major change in recommendations is that the terms habit and psychogenic cough be abandoned because they are out of date and inaccurate. Although the other recommendations are similar to those made in the 2006 guidelines,¹ the strength of the evidence for the recommendations

Acknowledgments

Author contributions: A. E. V. and R. S. I. have been the topic editors for this article, and all authors have participated in the development of the key questions using the PICOTS format, review of the data, and elaboration of recommendations, including their grading. M. H. M. has been the appointed methodologist and was among the investigators who conducted the systematic review that formed the basis for the recommendations.

Financial/nonfinancial disclosures: The authors have reported to the

References (28)

RS Irwin et al.
Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines
Chest
(2006)
Q Haydour et al.
Management and diagnosis of psychogenic cough, habit cough, and tic cough: a systematic review
Chest
(2014)
SZ Lewis et al.
Methodologies for the development of CHEST guidelines and expert panel reports
Chest
(2014)
SZ Lewis et al.
Methodologies for the development of the management of cough: CHEST guideline and expert panel report
Chest
(2014)
H Balshem et al.
GRADE guidelines: 3. Rating the quality of evidence
J Clin Epidemiol
(2011)
JC Andrews et al.
GRADE guidelines: 15. Going from evidence to recommendation—determinants of a recommendation's direction and strength
J Clin Epidemiol
(2013)
RJ Adams et al.
Associations of physical and mental health problems with chronic cough in a representative population cohort
Cough
(2009)
CT French et al.
Evaluation of a cough-specific quality-of-life questionnaire
Chest
(2002)
PV Dicpinigaitis et al.
Prevalence of depressive symptoms among patients with chronic cough
Chest
(2006)
Institute of Medicine
Clinical Practice Guidelines We Can Trust
(2011)

M Gay et al.

Psychogenic habit cough: review and case reports

J Clin Psychiatry

(1987)

AB Chang et al.

Cough quality in children: a comparison of subjective vs. bronchoscopic findings

Respir Res

(2005)

CJ Mello et al.

Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause

Arch Intern Med

(1996)

JT Power et al.

Nocturnal cough in patients with chronic bronchitis and emphysema

Am Rev Respir Dis

(1984)

Cited by (77)

Functional respiratory disorders in children
2023, Revue Francaise d'Allergologie
Les troubles fonctionnels respiratoires ou désordres respiratoires somatoformes (DRS) sont fréquents en pédiatrie. Ce sont des symptômes respiratoires ou des plaintes concernant la respiration, pour lesquels une étiologie organique n’est pas actuellement identifiée. Les DRS sont isolés ou souvent associés à une pathologie organique, avant tout l’asthme. Face à une gêne respiratoire, surtout en cas de discordance entre la plainte et les signes objectifs, il faut les évoquer et analyser la sémiologie respiratoire, ne pas hésiter à demander à l’enfant de reproduire le symptôme, s’aider d’autoquestionnaire, demander de filmer au domicile un épisode. La prise en charge est indispensable pour éviter une consommation médicale inadaptée, et la persistance des signes dans le temps.
Functional respiratory disorders or somatoform respiratory disorders (FRD) are common in pediatrics. These are respiratory symptoms, or complaints about breathing, for which an organic etiology is not currently identified. FRD are isolated or associated with an organic pathology, above all asthma. Faced with respiratory discomfort, especially in the event of a discrepancy between the complaint and the objective signs, it is necessary to analyze the respiratory semiology, do not hesitate to ask the child to reproduce the symptom, use the self-questionnaire; ask to film it at home. Management is essential to avoid inappropriate medical consumption, persistence of signs over time.
Predictors of treatment response to pregabalin in unexplained or refractory chronic cough
2023, Respiratory Medicine
Patients with chronic cough (>8 weeks) often remain symptomatic after appropriate investigations and therapeutic trials. Prior research has shown a benefit in certain individuals from pregabalin, but clinical improvement is quite unpredictable and variable.
The main objective of this study was to identify the demographic and clinical characteristics associated with a higher likelihood of cough improvement with a trial of pregabalin therapy.
50 consecutive patients with chronic cough were enrolled in this prospective cohort study. Subjects were prescribed pregabalin 75 mg oral qhs for 4 weeks followed by 75 mg oral bid. Leicester Cough Questionnaire (LCQ) was completed at treatment initiation and after 3 months of therapy. A comparison was performed between treatment responders (LCQ total score improvement ≥1.3) and non-responders.
56% of patients reported a LCQ total score improvement ≥1.3 (minimal clinically important difference). Responders to pregabalin therapy were more likely to have refractory (with underlying pulmonary disease) versus unexplained chronic cough (p = 0.01). Patients with significant improvement were also on average more symptomatic at baseline (mean LCQ total score 10.2 versus 13.0, p < 0.01). No significant relationship was identified with age, gender, body mass index, history of anxiety and/or depression, cigarette smoking history, or cough duration (p > 0.05). The unexplained chronic cough group had a strong female predominance (85.7% versus 40.9% for refractory cough, p < 0.01).
This is the first study that has investigated clinical predictors of treatment response to pregabalin in chronic cough patients. Further research is needed to develop therapies for subjects who do not improve with currently available neuromodulating medications.
Guidelines for the management of chronic cough in adults. Endorsed by the French speaking society of respiratory diseases (Société de Pneumologie de Langue Française, SPLF), the Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL), the Société Française de Phoniatrie et de Laryngologie (SFPL), the Société Nationale Française de Gastro-entérologie (SNFGE)
2023, Respiratory Medicine and Research
Patients with chronic cough experience a high alteration of quality of life. Moreover, chronic cough is a complex entity with numerous etiologies and treatments. In order to help clinicians involved in the management of patients with chronic cough, guidelines on chronic cough have been established by a group of French experts. These guidelines address the definitions of chronic cough and the initial management of patients with chronic cough. We present herein second-line tests that might be considered in patients with cough persistence despite initial management. Experts also propose a definition of unexplained or refractory chronic cough (URCC) in order to better identify patients whose cough persists despite optimal management. Finally, these guidelines address the pharmacological and non-pharmacological interventions useful in URCC. Thus, amitryptilline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are a mainstay of treatment strategies in URCC. Other treatment options, such as P2 × 3 antagonists, are being developed.
Guidelines for the management of chronic cough in adults
2023, Revue des Maladies Respiratoires
La toux chronique est à l’origine d’une altération majeure de la qualité de vie des patients. La prise en charge est complexe compte-tenu des étiologies nombreuses. Un groupe d’experts français propose des recommandations sur la toux chronique afin d’aider les cliniciens impliqués dans la prise en charge des patients tousseurs chroniques. Ces recommandations abordent notamment les définitions de la toux chronique et la prise en charge initiale des patients ayant une toux chronique. Les étiologies fréquentes et les différents examens complémentaires utiles à la prise en charge sont détaillés en prenant en compte le contexte clinique. Les experts proposent également une définition de la toux chronique réfractaire ou inexpliquée (TOCRI) afin de mieux identifier les patients dont la toux persiste malgré une prise en charge bien conduite. Ces recommandations traitent également des interventions pharmacologiques et non pharmacologiques nécessaires pour la toux chronique réfractaire ou inexpliquée. Ainsi, l’amitryptilline, la prégabaline, la gabapentine ou la morphine, associées à l’orthophonie et/ou la kinésithérapie constituent un pilier des stratégies thérapeutiques dans la TOCRI. D’autres options thérapeutiques, telles que les antagonistes de P2X3, constituent un espoir majeur pour les médecins et les patients.
Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.
Yardstick for managing cough, part 2: In children
2023, Annals of Allergy, Asthma and Immunology
Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to respiratory specialists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the evidence-based guidelines most of which have been developed from high-quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. Chronic cough in children is often benign and self-limiting. Using established and validated protocols and specific pointers (clues in history, findings on examination) can aid the clinician in identifying causes when present and improve outcomes. In this manuscript, part 2 of the 2-part series, we provide evidence-based, expert opinion recommendations on the management of chronic cough in the pediatric patient (<14 years of age).
The Evolving Clinical Practice of Chronic Cough
2022, Mayo Clinic Proceedings
Chronic cough, defined as a cough lasting for greater than 8 weeks, accounts for a substantial number of primary care and specialist consultations in the United States. Although cough can arise from a myriad number of serious respiratory diseases, attention has traditionally focused on diagnosing and treating gastroesophageal reflux, upper airway cough syndrome, and eosinophilic airway inflammation (asthma and nonasthmatic eosinophilic bronchitis) in patients with normal chest imaging. The newly described paradigm and entity of cough hypersensitivity syndrome (CHS) becomes useful when the etiology of cough remains elusive or when the cough remains refractory despite appropriate therapy for underlying causes. We present an update on the evolving understanding of refractory chronic cough and/or unexplained chronic cough as manifestations of laryngeal hypersensitivity and CHS. This includes a focus on understanding the pathophysiology underlying current and novel therapeutics for CHS, while also ensuring that common causes of chronic cough continue to be evaluated and treated in a systematic multidisciplinary manner.

View all citing articles on Scopus

DISCLAIMER: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/CHEST-Guidelines.

FUNDING/SUPPORT: CHEST was the sole supporter of these guidelines, this article, and the innovations addressed within.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

View full text

Chest

Evidence-Based MedicineSomatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Section snippets

Summary of Recommendations/Suggestions

Materials and Methods

Results

Conclusions

Acknowledgments

Chest

Chest

Chest

Chest

J Clin Epidemiol

J Clin Epidemiol

Cough

Chest

Chest

Clinical Practice Guidelines We Can Trust

Psychogenic habit cough: review and case reports

J Clin Psychiatry

Cough quality in children: a comparison of subjective vs. bronchoscopic findings

Respir Res

Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause

Arch Intern Med

Nocturnal cough in patients with chronic bronchitis and emphysema

Am Rev Respir Dis

Evidence-Based Medicine
Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children