Psychogenic Cough Research Articles

Tic disorders in children in the outpatient practice of a medical psychologist

Background. The war in Ukraine is a factor of the psycho-emotional trauma in children. As you know, transient motor tics can be observed in almost 20 % of children in the world. Chronic tic and Tourette’s syndrome are also considered common among children. The purpose is to establish the prevalence of tic disorders among children who consult a medical psychologist, ta­king into account gender and age, to determine the directions of therapy. Materials and methods. The study was conducted from March 2023 to March 2024. Three hundred and five children (168 boys and 137 girls) aged 2 to 17 years were examined, who initially consulted a psychologist at the consultative diagnostic polyclinic of the National Specialized Children’s Hospital OHMATDYT. Results. Tic disorders were found in 31 (10.2 %) children: 15 (10.9 %) girls and 16 (9.5 %) boys. Girls with tics were significantly younger than boys with tics and girls from the comparison group. Chronic tic without vocalization was detected in 20 children, tic cough — in 5, vocal tics — in 3, Tourette’s syndrome in 3 cases (girls aged 8–10). Attention was drawn to the pronounced anxiety of the children, which manifested itself particularly in the subjects of their drawings. None of the children showed signs of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection or pediatric acute-onset neuropsychiatric syndrome. The therapy included educational interventions and cognitive behavioral therapy. Conclusions. Every tenth child, who initially consults a medical psychologist, suffered from tic disorder, which required educational activities and cognitive behavioral therapy.

Diagnostic utility of spirometry for children with induced laryngeal obstruction or chronic non-specific cough

PurposeTo determine the diagnostic utility of spirometry in distinguishing children with Induced Laryngeal Obstruction (ILO) or chronic non-specific cough (a.k.a. tic cough) from those with mild or moderate to severe asthma. MethodsRetrospective cross sectional design. Children diagnosed with ILO (N = 70), chronic non-specific cough (N = 70), mild asthma (N = 60), or moderate to severe asthma (N = 60) were identified from the electronic medical record of a large children's hospital. Spirometry was completed before ILO, non-specific cough, or asthma diagnoses were made by pediatric laryngologists or pulmonologists. Spirometry was performed following American Thoracic Society guidelines and was interpreted by a pediatric pulmonologist. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1), FEV1/FVC Ratio (FEV1/FVC), Forced Mid-Expiratory Flow 25‐–75 % (FEF25–75%), pulmonologist interpretation of flow volume loops, and overall exam findings were extracted from the medical record. ResultsNinety seven percent of children with ILO or chronic non-specific cough presented with spirometry values within normative range. Patients with ILO, non-specific cough, and mild asthma presented with FVC, FEV1, FEV1/FVC, and FEF25–75% values in statistically similar range. Children with moderate to severe asthma presented with significantly reduced FVC (p < .001), FEV1 (p < .001), FEV1/FVC (p < .001), and FEF25–75% (p < .001) values when compared with patients in the other groups. Flow volume loops were predominantly normal for children with ILO and non-specific cough. ConclusionsFindings indicate that ILO and chronic non-specific cough can neither be diagnosed nor differentiated from mild asthma using spirometry alone. Spirometry should therefore be used judiciously with this population, bearing in mind the limitations of the procedure. Future research should determine the most effective and efficient ways of delineating ILO and non-specific cough from other respiratory conditions in children.

Successful treatment of habit cough using suggestion therapy

Background: Habit cough is one of the causes of chronic cough in children. Many cases do not reach the psychiatrists due to lack of specific clinical features and diagnostic tests. We present a case of 13 year old boy with habit cough who was successfully treated by suggestion therapy and lignocaine based mouth gargle as a distracter. This case highlights that suggestion therapy can be an important treatment option to this fairly common condition.

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

Behavioral 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. A 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. Cough 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). Although randomized clinical trials are needed, these data suggest that BCST is a low-risk, effective treatment for children with nonspecific cough.

Psychosomatic functional disorders in pulmonary practice

The relevance of studying psychosomatic disorders in somatic clinical practice (including pulmonary practice) stems from the significant prevalence of these disorders, as well as the difficulties in making a differential diagnosis and choosing the most effective tactics for patient management.The aim of this review was to analyze the available publications on the problem of psychosomatic functional disorders in pulmonary practice, such as hyperventilation syndrome (HVS), including HVS associated with Severe Acute Respiratory Syndrome-related CoronaVirus 2 (SARS-CoV-2) infection, vocal cord dysfunction, and psychogenic cough. The article discusses clinical features of different variants of functional disorders and accompanying psychopathological symptoms (panic attacks, generalized anxiety, etc.), as well as psychogenic factors of their manifestation and changes in the clinical features over time. The corresponding section briefly summarizes current ideas about approaches to effective treatment of this group of disorders and prevention of their chronification.Conclusion. The clinical heterogeneity of psychosomatic functional disorders in pulmonological practice has been demonstrated, as have important aspects of the diagnosis and treatment of these disorders.

Evaluation of patients with chronic cough in school age children

Introduction: Chronic cough is a common problem in childhood. Simple viral infections can cause chronic cough, as well as underlying progressive diseases. For this reason, guidelines that can be applied in clinical practice are very valuable. In our study, we aimed to evaluate our school-age patients with chronic cough in the light of the literature.&#x0D; Material Method:&#x0D; The files of children over the age of 6 who applied to the pediatric allergy outpatient clinic between January 2022 and June 2022 with cough for more than 4 weeks were evaluated retrospectively.&#x0D; Results:&#x0D; 182 patients aged 6-17.9 years were included in the study. 62.1% of the patients were male, the mean age was 9.8±3.8 years. 32.4% of our patients had asthma; 43.4% Upper airways cough syndrome (20.9% sinusitis, 17.6% allergic rhinitis, 4.9% non-allergic rhinitis); 7.68% Protracted bacterial bronchitis; 6.59% postinfectious cough; 4.9% of our patients had psychogenic cough; 2.2% Gastroesophageal reflux disease; 1.1% patients had brochiectasis; 1.1% of patients had primary ciliary dyskinesia; 0.55% of the patients were diagnosed with eosinophilic esophagitis.&#x0D; Conclusion:&#x0D; Chronic cough in childhood can be caused by many different underlying diseases. It is observed that patients often use drugs such as antibiotics and symptom relievers unnecessarily. Accurate evaluation of patients, especially taking a detailed history, is very important in the management of these cases. It is very valuable to evaluate each patient individually.

Habit cough in children

Cough is one of the most common presenting complaints in childhood. Chronic cough has many possible causes, and this symptom often results in extensive investigations, treatments and anxiety. Habit (habit-tic) and somatic cough disorder (also known as psychogenic cough) is one of the more common underlying diagnoses eventually reached. Habit cough often follows an upper respiratory infection. It is a dry, repetitive, honking, disruptive cough. Characteristically, habit cough usually reduces with distraction, and disappears in sleep. A good detailed history and physical examination, coupled with (normal) basic investigations will usually suffice in diagnosing habit cough – it is important to avoid extensive investigations and unnecessary treatments. However, it is also imperative to note that some children may have both pathological and habit or psychogenic cough. The mainstay of management of habit cough is education and addressing any underlying psychosocial stressors. Various forms of psychotherapies and physiotherapies (cough suppression techniques) have been shown to be effective. With intervention, most children with habit cough will achieve complete resolution, or at least improvement in symptoms. This short article is aimed at healthcare professionals working with children and gives practical advice about investigation and management of suspected habit cough in children and young people.

Habit cough is a cause of chronic cough in adults

Habit cough is a cause of chronic cough in adults

A Review, Update, and Commentary for the Cough without a Cause: Facts and Factoids of the Habit Cough

A habitual cough, persisting after the cause is gone, was described in a 1694 medical book. Successful treatment of this disorder known as habit cough was reported in 1966 by the "art of suggestion". The purpose of this article is to provide the current basis for diagnosis and treatment of the Habit Cough Syndrome. The epidemiology and clinical course of habit cough were reviewed; original data were obtained from three sources. Unique clinical presentation was the basis for diagnosis of habit cough. Diagnosis was made 140 times with increasing frequency over 20 years at the University of Iowa clinic and 55 times over 6 years at a London clinic. Suggestion therapy provided more frequent cessation of cough than just reassurance. A Mayo Clinic archive of chronic involuntary cough found 16 of 60 still coughing 5.9 years after initial evaluation. Ninety-one parents of children with habit cough and 20 adults reported cessation of coughing from viewing a publicly available video of successful suggestion therapy. Habit cough is recognizable from the clinical presentation. It is effectively treated in most children by suggestion therapy in clinics, by remote video conferencing, and by proxy from viewing a video of effective suggestion therapy.

Methacholine and FeNO Measurement in Patients with Habit Cough.

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. 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. 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. 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.

Evaluation of Chronic Cough Etiologies in Children

Objective: Cough is one of the leading causes of hospitalization in children worldwide. It should be considered important because it can be a symptom of various serious diseases and affects the quality of life of the child. A differential diagnosis should be performed on all children with a chronic cough. This study aimed to determine the etiologies in patients evaluated for chronic cough. Material and Methods: The study included patients admitted to the pediatric immunology and allergy outpatient clinic, with the complaint of chronic cough between the ages of 0–18 years. Clinical and demographic characteristics of patients were recorded. Results: This study included 323 patients between the ages of 0-18years. The median age of the patients was 7 (interquartile range: 5-9.7) years. One hundred and forty five (45%) of the patients were female. One hundred seventy-nine (55.4%) patients had a family history of atopic diseases such as asthma and/or allergic rhinitis. The presence of aeroallergen sensitivity was demonstrated in 127 patients. One hundred and forty-four (44.6%) patients were diagnosed with asthma, 75 (23.2%) patients with wheezing, 54 (16.7%) patients with post-infectious cough, 43 (13.3%) patients with postnasal drip syndrome, 4 (1.2%) patients with gastroesophageal reflux, 2 (0.6%) patients with foreign body aspiration, and 1 (0.3%) patient with psychogenic cough. Moreover, two patients with asthma, and one patient with wheezing had reflux symptoms in addition to the diagnosis of asthma and wheezing. One patient was found to have a partial IgA deficiency, and 18 patients had hypogammaglobulinemia. Immunoglobulin replacement therapy was initiated for a patient with hypogammaglobulinemia. Of the 219 patients diagnosed with asthma or wheezing, 144 had an atopic disease in the family (p&amp;lt;0.001). It was found that one hundred and eighty-five patients (57.3%) had domestic smoke exposure. Furthermore, smoke exposure was observed in 58 (77.3%) of 75 patients under the age of 6 years who were followed up with the diagnosis of wheezing (p= 0.010). Conclusion: In our study, asthma, which is one of the most common causes of chronic cough in the literature, was found to be the most common cause. For a correct approach when making a differential diagnosis in pediatric patients presenting with chronic cough, the patient’s history, physical examination, laboratory tests, and risk factors should be evaluated as a whole with systematic evaluation.

Dijagnostika i terapija hroničnog kašlja

A cough that lasts for more than 8 weeks in adults (those older than 15 years) and more than 4 weeks in children is considered chronic and poses a significant health problem, as it can lead to feelings of fatigue, sleep disturbances, hoarseness, disruption of daily activities, vomiting, and often in women, even incontinence. The differential diagnosis of chronic cough in adults and children has its specificities. In certain cases, the etiological factor remains unknown when referring to unexplained (idiopathic) chronic cough. This paper presents the results of a systematic review of publications in medical databases (PubMed) and guidelines from the European Respiratory Society (ERS) and the American College of Chest Physicians (CHEST), related to the diagnosis and treatment of chronic cough. Diagnostic investigations should be focused on the most common causes of chronic cough. In adults, these include asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, lung malignancy, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and upper airway cough syndrome. In children, the most common causes of chronic cough are asthma, protracted bacterial bronchitis, cystic fibrosis, primary ciliary dyskinesia, bronchiectasis, tracheobronchomalacia, pertussis, habitual (psychogenic) cough, and foreign body aspiration. The treatment primarily involves excluding medications that might have chronic cough as an adverse effect. Therapy is directed toward treating the underlying cause of chronic cough. If the cough persists despite treatment (refractory cough) or if it's idiopathic, neuromodulatory medications are employed (opioids, gamma-aminobutyric acid analogs, tricyclic antidepressants). Therapeutic options also include breathing and vocal techniques, superior laryngeal nerve blocks, and vocal cord medialization injections. Drugs directly inhibiting sensory receptors (P2X3, TRPV-1, and NK-1 inhibitors) are currently under clinical trial investigation. The use of validated tests is crucial for assessing therapeutic effectiveness. The etiological factors of chronic cough can have both infectious and non-infectious origins and are not always related to lung diseases. Considering that chronic cough is regarded as a condition of hypersensitivity, when causal treatment does not yield satisfactory results or when dealing with idiopathic chronic cough, therapy is directed towards central or peripheral neuromodulation, as well as techniques involving breathing and vocal production.

Psychiatric adverse events reported after COVID-19 vaccination in the European Union (EU), the United States (US) and the United Kingdom (UK)

IntroductionSeveral psychiatric adverse events can occur after vaccination. Passive surveillance reporting systems can support the identification of rare adverse events and contribute to hypothesis generation for potential causal associations.ObjectivesTo describe the psychiatric adverse reactions associated with various COVID-19 vaccines reported in the WHO database (VigiBase®)MethodsWe for individual case reports (ICSRs) for “Psychiatric disorders” linked to COVID-19 vaccines authorized in the EU, the US and the UK. Reporting rates were calculated using the number of administered doses as a denominator. Disproportional reporting was investigated through frequentist and Bayesian approaches by the calculation the information component (IC) for adverse psychiatric adverse not included in the vaccine label.Results63322 ICSRs including 76,163 psychiatric adverse events were identified, 21878 (34.6 %) were serious events. Mean age in the reports was 48.8 years old (SD: 17.8) and involved 44441 (70.2%) female and 17975 (28.4%) women; sex was not specified in 906 (1.4%) reports. Rate of reported psychiatric adverse events per million administered doses were 52.0, 110.3, 164.8 and 170.8 for Tozinameran/Cominarty (Pfizer-BioNTech), Elasomeran (Moderna), Vaxzevria (AstraZeneca) and Ad26.COV2-S (Janssen) vaccines respectively. UK recorded the highest rates. The most frequently reported events were insomnia (21.6%), confusional state (13.6%) and anxiety (13.5%). Disproportionality was found for: habit cough (IC:3.6), clinomania (IC: 2.2), exploding head syndrome (IC: 2.2) and autoscopy (IC: 2.1).ConclusionsRates of reported psychiatric adverse events are very low. Doctors and patients should be aware of these potential adverse reactions. Continuing monitoring of emerging potential safety signals is advised.DisclosureNo significant relationships.

Revised Korean Cough Guidelines, 2020: Recommendations and Summary Statements.

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient’s quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

Increased Incidence of Stress-related Tic Habit Cough in Children During the Recent Greek Financial Crisis.

Tic habit cough (THC) is not easily recognized and requires a high index of suspicion. Since there is evidence for stress-related etiology, the study presents our experience during the eight-year period of the recent Greek financial crisis. This is a descriptive prospective cross-sectional clinical study using a consistent approach to diagnosis, possible triggers and treatment options. Fifty-one children (26 girls, age 9.5±3.1y) from a total of 3,793 new referrals for chronic cough fulfilled the criteria of THC (1.34%). Incidence rates per 1,000 person-years were 1.34 (95%CI=0.34-5.40), 3.91 (95%CI=1.86-8.19), 4.03 (95%CI=2.01-8.06) and 14.60 (95%CI=10.43-20.44) for every two years. Poisson analysis showed an increased trend during the four time periods with an incidence rate ratio equal to 2.21 (95%CI=1.58-3.09, p<0.001). THC was mainly attributed to learning difficulties, as well as stress-related impact of peer or family bullying, family financial problems and child anxiety disorders. The incidence of THC is associated with the negative aspects of stressors during a period of financial crisis. The potential underlining psycho-physiological mechanisms are discussed as well as the fact that prompt diagnosis may result in successful interventions.

Cough without a cause: Habit cough / Tic cough

Cough without a cause: Habit cough / Tic cough

Wheeze and cough measurements at night in children with respiratory symptoms

BackgroundNocturnal cough and wheeze are important symptoms when diagnosing any respiratory disease in a child, but objective measurements of these symptoms are not performed.MethodsThe aim of our study was to analyze the use of an automated detection system to assess breath sounds objectively in comparison to cough and wheeze questionnaires and to evaluate its feasibility in clinical practice.ResultsForty-nine recordings of thirty-nine children were processed (asthma n = 13; cystic fibrosis n = 2; pneumonia n = 5; suspicion of habit cough n = 7; prolonged, recurrent or chronic cough n = 13), and cough and asthma scores were compared to the objective nocturnal recordings. Time for audio-validation of recordings took between 2 and 40 min (mean: 14.22 min, (SD): 10.72). Accuracy of the automated measurement was higher for cough than for wheezing sounds. Nocturnal cough readings but not wheeze readings correlated with some of the corresponding scores.ConclusionTo our knowledge this is the first study using a new device to assess nocturnal cough and obstructive breath sounds objectively in children with a wide variety of respiratory diseases. The assessment proved user friendly. We obtained additional information on nighttime symptoms, which would otherwise have remained obscure. Further studies to assess possible diagnostic and therapeutic benefits of this device are needed.

CHLORPROMAZINE TO TREAT ADULT SOMATIC COUGH SYNDROME

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Chlorpromazine is a centrally acting dopamine antagonist used for psychogenic singultus. Somatic cough syndrome is associated with an underlying psychiatric disorder and improves with behavioral or pharmacologic therapy. Diagnostic criteria include cough for >6 months with disruption of daily life and associated anxiety. CASE PRESENTATION: A 46 year old female presented with worsening dyspnea secondary to heavy coughing spells. Chest radiograph was unremarkable. CT angiogram showed atelectasis and possible pneumonia. She was treated with ceftriaxone and azithromycin for CAP, however cough did not improve. The patient developed stridor and hypoxic and hypercarbic respiratory failure requiring endotracheal intubation. Laryngoscopy did not demonstrate inflammation or edema. She remained intubated and sedated for two days. After extubation, the cough returned. Physical examination was benign. The patient’s breathing was unlabored and she was able to speak in full sentences. No cough was present while asleep. Repeat imaging was unremarkable. She received ipratropium-albuterol nebs every 6 hours and albuterol PRN. Benzonatate, guaifenesin, codeine, and nebulized lidocaine were tried, but the cough persisted. The decision was made to use chlorpromazine 25 mg PO every 8 hours. Patient’s cough resolved completely after the second dose. Psychiatry consultation attributed the patient’s cough to generalized anxiety disorder. She was started on duloxetine 60 mg daily with recommendation to titrate off the chlorpromazine with improvement of cough. Six months later, our patient re-presented similarly – intractable cough with respiratory failure requiring endotracheal intubation. Given our previous evidence of the efficacy of chlorpromazine in resolution of her cough, patient was extubated on day 2 with initiation of 25 mg chlorpromazine q8h. Once again, her cough resolved after the second dose. DISCUSSION: Singultus and cough have similar mechanisms. They activate neural reflex arcs including the vagus and phrenic nerves leading to spasmodic contraction of the diaphragm. This action is mediated in part by dopaminergic activity. Multiple neuromodulatory agents have been studied, with improvement of refractory singultus. Pregabalin with speech therapy has been evaluated in an RCT for refractory cough with better outcomes over therapy alone. Also, a case study demonstrated resolution of refractory cough with risperidone plus therapy. This suggests that decreased neurotransmitter activity is beneficial in treatment of refractory cough. Chlorpromazine’s dopamine antagonism results in decreased reflex activation, likely leading to improvement of singultus and cough. CONCLUSIONS: Neuromodulation should be further studied for treatment of somatic cough syndrome. Reference #1: Irwin RS et al. Habit Cough, Tic Cough, and Psychogenic Cough in Adult and Pediatric Populations. CHEST. 2006; 129(1):174-179. doi.org/10.1378/chest.129.1_suppl.174S Reference #2: Steger M et al. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015; 42(9):1037-1050. doi:10.1111/apt.13374 Reference #3: Vertigan AE et al. Pregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough. CHEST. 2016; 149(3):639-648. doi.org/10.1378/chest.15-1271 DISCLOSURES: No relevant relationships by Michael Bonk, source=Web Response No relevant relationships by Firth Bowden, source=Web Response No relevant relationships by Kia Ghiassi, source=Web Response No relevant relationships by Ananya Nanduri, source=Web Response

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

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.

Breathing pattern disorders (dysfunctional breathing) characteristics and outcomes of children and young people attending a secondary care respiratory clinic.

We retrospectively audited the health records of 18 patients with breathing pattern disorders (BPDs), who were diagnosed in our respiratory clinic (2015-2018), and then referred onto our dysfunctional breathing care pathway to a specialist speech and language therapist. The age of the patients ranged from 11 to 16 years (median: 14 years, 14 female/4 male patients). Comorbidities included the following: 16 patients had asthma, 2 patients had a tracheoesophageal fistula and esophageal atresia repair, one patient suffered from chronic regional pain syndrome, and one patient had chronic fatigue syndrome. The commonest BPD was induced laryngeal obstruction (ILO) in 16 patients (exercise-induced laryngeal obstruction [EILO] in 15). Other types of BPDs included hyperventilation syndrome in seven patients, psychogenic cough in eight, and dysphonia in one. A single BPD was present in 6 patients (mainly EILO), and two or more BPDs were present in 10 patients. Inducers of BPD symptoms were as follows: exercise in 16 patients, bullying in 3, anxiety in 14, emotions and stress in 11, weather in 3, posture in 1, and odors in 3. Significant school absenteeism was observed in most of the patients (2 weeks to 24 months). Significant delays in diagnosing BPD were noted (range: 1-24 months and median: 6 months). Emergency calls occurred in 14 patients, with one patient presenting with ILO and comorbidity of asthma needing intubation and ventilation. A 1-year follow-up of patients showed that there was a complete resolution of BPD in two patients, 14 had good control of BPD with confidence in ability to control their symptoms, showing improved morbidity, two had no improvement, and one lost to follow-up. It is important to recognize and treat BPD early to limit the significant morbidity that adversely impacts the quality of life.