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Original Research: Signs and Symptoms of Chest Diseases |

Management and Diagnosis of Psychogenic Cough, Habit Cough, and Tic CoughPsychogenic, Habit, and Tic Cough: A Systematic Review FREE TO VIEW

Qusay Haydour, MD; Fares Alahdab, MD; Magdoleen Farah, MBBS; Patricia Barrionuevo, MD; Anne E. Vertigan, PhD; Peter A. Newcombe, PhD; Tamara Pringsheim, MD; Anne B. Chang, PhD; Bruce K. Rubin, MD; Lorcan McGarvey, MD; Kelly A. Weir, BSpThy, MSpPath; Kenneth W. Altman, MD, PhD; Anthony Feinstein, PhD; Mohammad Hassan Murad, MD, MPH; Richard S. Irwin, MD, Master FCCP
Author and Funding Information

From the Mayo Clinic (Drs Haydour, Alahdab, Farah, Barrionuevo, and Murad), The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN; Unidad de Conocimiento y Evidencia (Dr Barrionuevo), Universidad Peruana Cayetano Heredia, Lima, Peru; John Hunter Hospital (Dr Vertigan), Department of Speech Pathology, Newcastle, NSW, Australia; University of Queensland (Dr Newcombe), School of Psychology, Brisbane, QLD, Australia; University of Calgary (Dr Pringsheim), Calgary, AB, Canada; Royal Children’s Hospital and Menzies School of Health Research (Dr Chang), Charles Darwin University, Brisbane, Brisbane, QLD, Australia; Children’s Hospital of Richmond and Virginia Commonwealth University (Dr Rubin), Richmond, VA; Centre for Infection and Immunity (Dr McGarvey), The Queen’s University of Belfast, Belfast, Northern Ireland; Royal Children’s Hospital Department of Speech Pathology and Queensland Children’s Medical Research Institute (Ms Weir), The University of Queensland, Brisbane, QLD, Australia; Mount Sinai Hospital (Dr Altman), New York, NY; Sunnybrook Health Sciences Centre (Dr Feinstein), Toronto, ON, Canada; and UMass Memorial Medical Center (Dr Irwin), Worcester, MA.

CORRESPONDENCE TO: Qusay Haydour, MD, 257 Napa Dr, Augusta, GA 30909; e-mail: q.haydour@gmail.com


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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


Chest. 2014;146(2):355-372. doi:10.1378/chest.14-0795
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BACKGROUND:  Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology.

METHODS:  We conducted a systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic, and habit cough. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched from the earliest inception of each database to September 2013. Content experts were contacted, and we searched bibliographies of included studies to identify additional references.

RESULTS:  A total of 18 uncontrolled studies were identified, enrolling 223 patients (46% male subjects, 96% children and adolescents). Psychogenic cough was the most common descriptive term used (90% of the studies). Most of the patients (95%) had no cough during sleep; barking or honking quality of cough was described in only eight studies. Hypnosis (three studies), suggestion therapy (four studies), and counseling and reassurance (seven studies) were the most commonly used interventions. Hypnosis was effective in resolving cough in 78% of the patients and improving it in another 5%. Suggestion therapy resolved cough successfully in 96% of the patients. The greatest majority of improvements noted with these forms of therapy occurred in the pediatric age group. The quality of evidence is low due to the lack of control groups, the retrospective nature of all the studies, heterogeneity of definitions and diagnostic criteria, and the high likelihood of reporting bias.

CONCLUSIONS:  Only low-quality evidence exists to support a particular strategy to define and treat psychogenic, habit, and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.

Figures in this Article

Cough is one of the most frequently encountered symptoms in medical practice. It plays an essential role in clearing the airway of secretions and foreign bodies; however, it can pose huge social and economic burdens on some patients.14 Chronic cough, persisting beyond 4 weeks in children and 8 weeks in adults, can become protracted and cause anxiety and social discomfort. It can be the only presenting symptom in many pulmonary and extrapulmonary conditions. Chronic cough has to be approached systematically to better evaluate and reach the right diagnosis.5,6 Upper airway cough syndrome (previously referred to as postnasal drip syndrome), asthma, nonasthmatic eosinophilic bronchitis, and gastroesophageal reflux disease are the most common causes of chronic cough in adults.7 However, an etiology of cough is not always easily identified even after a thorough systematic investigation, and psychologic and neurologic conditions are in the differential diagnosis in both children and adults.8

Various terms, including habit cough, psychogenic cough, and tic cough, were used to describe cases without a clear pulmonary or extrapulmonary (eg, gastroesophageal reflux disease) etiology in the presence of some suggestive clinical characteristics and/or an association with psychologic issue. However, these terms are not clearly defined or distinguished from each other. The literature suggests that the classic features of these conditions include repetitive, loud, dry, honking cough and absence of cough during nighttime.912 Holinger and Sanders13 found that psychogenic cough was the second most common cause of chronic cough in children aged 6 to 16 years. Many interventions, including pharmacotherapy, behavioral modifications, and psychotherapy, were used, but none has been rigorously evaluated.911,14 The concept of psychogenic cough and its related disorders as reviewed here is distinct from other presumed etiologies of the unexplained cough, such as “neurogenic cough” or postviral vagal neuropathy (which is considered more strictly to be a disorder of the peripheral receptors or brainstem reflex feedback loop).

The American College of Chest Physicians (CHEST) develops clinical practice guidelines to help patients and physicians in decision-making. To aid in the development of guidelines for these challenging conditions, we conducted a systematic review of the available literature on the management of habit cough, psychogenic cough, and tic cough. Knowing of the paucity of controlled trials and the heterogeneity of diagnostic terms, we included all study designs and descriptive diagnostic terms.

This systematic review follows an a priori established protocol developed by the guideline methodologist and selected members of the CHEST expert cough panel. This report was written following the preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.15

Eligibility Criteria

We searched for studies of any study design that enrolled children or adults with psychogenic cough, habit cough, and tic cough. We included studies regardless of their language or publication status. Case series with two or more patients were included. Single-case reports were excluded.

Study Identification

We conducted a comprehensive search of several databases from each database’s earliest inception to September 2013. The databases included Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycInfo, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The search strategy was designed and conducted by an experienced librarian with input from the guideline methodologist and selected members of the CHEST expert panel. The search used both controlled vocabulary and keywords. The strategy used is described in e-Appendix 1. The reference lists from the narrative reviews and existing guidelines1618 were searched, and consultation with experts in the field was performed to obtain any additional references that might have been missed by the electronic search strategy.

Reviewers working independently and in duplicate reviewed all abstracts. Upon retrieval of potentially eligible studies, the full-text publications were evaluated for eligibility. The chance-adjusted inter-reviewer agreement was calculated using the κ statistic for full text screening (κ = 0.80). Disagreements were resolved by a third reviewer.

Quality Assessment

Reviewers working independently and in duplicate analyzed the full text of eligible articles to assess the reported quality of the methods. Since all the included studies were case series, a modified Newcastle-Ottawa scale was used.19 We assessed the following four elements: selection of patient, percent lost to follow-up, ascertainment of outcome, and length of follow-up.

Data Extraction

Reviewers working independently and in duplicate used a standardized Internet-based form to extract for each eligible study the following data items: study design, study population, study main objective, number of patients, age, sex, number of children, description of cough (duration, frequency, severity, triggers, cough during sleep, and associated symptoms), validated cough assessment tools, impact on school or job, failure of conventional treatments, length of follow-up, and number of patients who improved with or failed the treatment.

Characteristics of Included Studies

The study selection process is depicted in Figure 1. This evidence summary included 223 patients enrolled in 18 uncontrolled studies published between 1966 and 2007. Of the 223 patients, 81 were male (46% of patients where sex was reported). Of the 18 studies, 13 enrolled children and adolescents only and two studies enrolled mainly adults. Of the 170 patients in whom age was reported, 96% were children and adolescents. All the included studies were retrospective case series or case reports. More than one-half of the 223 patients were reported in three larger case series: Anbar and Hall,20 Bhatia et al,11 and Cohlan and Stone.21 The characteristics of included studies are summarized in Table 1. The description of cough is available in Table 2. The methodologic quality indicators of the studies are in Table 3. In general, the studies were uncontrolled and considered to be at high risk for bias.

Table Graphic Jump Location
TABLE 1  ] Characteristics of Included Studiesa

NR = not reported.

a 

All included studies were retrospective and uncontrolled.

b 

Both Blager et al31 and Gay et al32 reported treating the same four patients. Therefore, we included only Blager et al31 and extracted data from both.

Table Graphic Jump Location
TABLE 2  ] Cough Characteristics

URI = upper respiratory tract infection.

Table Graphic Jump Location
TABLE 3  ] Methodologic Quality Indicators
Cough Characteristics

Psychogenic cough was the term used in > 90% of the studies either exclusively or with other terms. Six studies used the terms habit and psychogenic interchangeably. Tic cough was not used exclusively in any study, yet the term psychogenic cough tic was mentioned in three studies. None of the patients had any motor tics other than those affecting the larynx; however, one study reported twin patients with Tourette syndrome who had phonic tic manifested as cough tic.36 None of the studies used any validated cough assessment tool. There were no clear diagnostic criteria followed in any of the studies other than describing the symptoms with which the patients presented. Nonproductive explosive barking or honking cough were the most common reported cough features, but these characteristics were only reported in eight of the studies. Five percent of patients (seven of 147 patients for whom this information was reported) had cough during sleep. Duration of cough varied widely among patients, with a range of 2 weeks to 16 years. About one-half of the studies reported triggers and precipitating factors, of which upper respiratory infections and social distress were the most predominant (Table 2).

Four studies11,20,28,31 reported that some of their patients were diagnosed with comorbid psychiatric disorders. The diagnosis was obtained through formal psychiatric evaluation in three of the studies. Bhatia et al11 reported that 20 patients (62% of total patients) had comorbid psychiatric disorders that were diagnosed according to International Classification of Diseases, 10th revision; the three most common were conversion disorder (22%), mixed anxiety and depressive disorder (12%), and generalized anxiety disorder (10%). Anbar and Hall20 reported that conversion disorder was diagnosed in six patients (11% of total patients) and anxiety disorder in one patient (2%). Blager et al31 reported that three patients (75%) in their study met the criteria for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-3 of conversion disorder and one patient met the criteria for somatization disorder. Bordoy et al28 reported that all six patients in their study had generalized anxiety disorder. The social and personal burdens of this cough on children were reported in eight studies in which > 69 patients missed a period of school attendance ranging from a few days to 6 months. The professional and social lives of four adult patients were also affected and disturbed.

Interventions

Fourteen studies reported using conventional pharmacologic interventions (mostly in children) prior to the diagnosis of psychogenic cough, including antibiotics, cough suppressants, antihistamines, bronchodilators, and steroids (Table 2). However, most of these interventions were briefly discussed, and no estimate of effects was reported. In general, studies reported lack of benefit of pharmacologic interventions and focused on nonpharmacologic interventions. In terms of antipsychotic medications, Tan et al35 reported two boys (twins) with chronic cough that turned out to be phonic tic of Tourette syndrome. One of the boys was successfully treated with haloperidol, whereas cough spontaneously resolved in the other boy.

Nonpharmacologic interventions were reported in most studies (Table 4). The effect of these approaches in the different studies is summarized in Table 5. Hypnosis, suggestion therapy, counseling, and reassurance were the most commonly reported interventions.

Table Graphic Jump Location
TABLE 4  ] Nonpharmacologic Interventions
a 

This represents patients’ percent of the total 223 patients.

Table Graphic Jump Location
TABLE 5  ] Effects of Interventions
Hypnotherapy/Self-Hypnosis

Hypnosis was evaluated in 96 patients who received the hypnosis instructions from a pulmonologist or psychologist trained in hypnosis. Cough resolved in 78% and improved in 5% of the patients.

Suggestion Therapy

Four studies used suggestion therapy, and two of them also used either a bed sheet wrapped around the patient’s chest or nebulized lidocaine diluted in normal saline as a distractor. Cough resolved in 96% of the 52 patients who received the intervention.

Reassurance, Counseling, Referral to Psychologist, and Appropriate Medications

Seven studies used a mix of interventions, including reassurance, counseling, relaxation techniques, referral to a psychologist, psychotherapy, and appropriate medications (tranquilizers, anxiolytic, and antidepressants). Of patients who received these interventions, 93% showed improvement in cough.

Vocal-Fold Injection With Botulinum Toxin Type A

Sipp et al34 reported treating three cases of debilitating cough with vocal-fold injection of botulinum toxin type A. The treatment was reported as effective in breaking the cough cycle in all three children. However, the cough recurred after a period of time ranging from 10 days to 2½ months and behavioral therapy was successful in controlling the cough afterward.

Voice Therapy Techniques and Cognitive Psychotherapy

Blager et al31 showed that voice therapy techniques and psychotherapy were effective in improving cough in three of the four adult patients who received the intervention. Cognitive psychotherapy was reported in one study to be an effective treatment of two cases of psychogenic cough.

We conducted a systematic review to summarize the evidence supporting the different treatment strategies for psychogenic, habit, and tic cough. We found 18 studies that involved 223 patients. Different terms were used in the literature to describe the cough; 10 terms were reported in one study.11 We found low-quality evidence supporting all the strategies used in the studies, because of the uncontrolled (noncomparative) nature of each of the studies.36 In addition, we consider the presence of reporting bias likely to be very high. In general, pharmacologic interventions were reported to be ineffective. Several nonpharmacologic strategies were reported to be effective.

Suggestion therapy techniques essentially referred to the process of the physician convincing the patient that he or she can control the cough by resisting the urge to cough. The physician explains the nature of the cough to the patient and the patient’s family and expresses confidence in the patient’s ability to stop the cough. Distractors of a bed sheet wrapped around the patient’s chest or nebulized lidocaine diluted in normal saline have been used during the process. The role of the distractor is to help patients control their cough and that should be explained clearly to the patients in a way that corresponds to the nature of the cough.14

Despite the lack of well-defined diagnostic criteria, the literature has suggested that cases of psychogenic, habit, or tic cough have some common clinical characteristics that predominate in many of the reported cases. It has been reported that a barking or honking quality of cough and absence of cough at night are suggestive of psychogenic, habit, and tic cough.32 However, barking or honking cough was only present in eight of the studies and nighttime coughing was reported in three studies in this review. A prospective study in adults showed that the absence of cough during sleep is not diagnostically helpful because other etiologies (eg, chronic bronchitis and emphysema) can present with the same feature.37 Moreover, in another prospective study in adults, honking and barking characteristics were also found not to be useful in diagnosing the cause of cough.38 Given the lack of both specific clinical features and diagnostic tests, cases of psychogenic cough have become essentially a diagnosis of exclusion.3 Hence, diagnostic tests have been used to rule out other possible, more common, etiologies of cough before making a diagnosis of psychogenic, tic, or habit cough.

Of note is that the word “psychogenic” does not appear as a descriptor in any of the DSM-5 diagnostic categories used to define physical symptoms that are incompatible with recognized neurologic or medical conditions. Furthermore, the word “organic” was deleted from the DSM taxonomy in 1994, reflecting a consensus that all mental phenomena arise from a disturbance in brain function. Changing semantics, however, is a lot easier than changing traditions and clinical practices. Both terms linger prominently, as the current literature relating to cough reveals. The DSM-5 categories that capture what has been termed psychogenic cough are either somatic symptom disorder or conversion disorder. The term conversion applies only in the context of altered neurologic function, so if cough is viewed in this light, this would be the more correct of the two nomenclatures.39,40 Similarly, the term “habit disorders,” which previously was used to refer to tic disorders, trichotillomania, complex motor stereotypes, and skin picking, is no longer used in the DSM. By DSM nosology, an isolated and persistent tic cough or habit cough would be considered a chronic vocal tic disorder.

If one considers tic cough in the setting of chronic tic disorders such as Tourette syndrome or chronic vocal tic disorder, there is evidence supporting both pharmacologic therapy and behavioral therapy for tics. Coughing tics in Tourette syndrome are extremely common, and treatment strategies are directed at reducing tics as a whole in individuals with tic disorders. The Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders found high-quality evidence for the efficacy of pimozide, haloperidol, and risperidone for the treatment of tics; moderate-quality evidence for the efficacy of clonidine and guanfacine; low-quality evidence for the efficacy of fluphenazine, metoclopramide, aripiprazole, olanzapine, ziprasidone, topiramate, botulinum toxin injections, and cannabinoids; and very low quality of evidence for quetiapine, baclofen, and tetrabenazine.17 With respect to behavioral treatments, there was high-quality evidence for habit reversal therapy, and low-quality evidence for exposure and response prevention.18

Another category of persistent cough, which should not be confused with psychogenic cough, is unexplained cough. Unexplained, rather than idiopathic, cough was suggested by CHEST to describe cases where behavior modification and psychiatric therapy failed to resolve cough of unidentified organic etiology.16 Unexplained cough should only be considered after failing both to find a cause for cough and failing behavior modifications and psychiatric therapy.16 A careful evaluation should be undertaken, since inadequate diagnostic workup can lead to mistakenly overdiagnosing unexplained cough.41

Strengths and Limitations

The strengths of this systematic review include the comprehensive search of multiple databases without language restriction, selecting studies in duplicate, and collaborating with an interprofessional team of content experts from CHEST that includes pediatric, pulmonary, neurology, otolaryngology, and psychiatry expertise. To our knowledge, this is the only systematic review on the topic.

The limitations of this review mainly relate to the lack of comparative studies, the likelihood of publication bias, heterogeneity of terms used to describe the cough, and inconsistency in diagnostic criteria and approach across the studies. In addition, the number of patients enrolled in the studies is small.

Implications for Research and Practice

The lack of comparative evidence in this chronic and burdensome disorder is compelling. Prospective patient registries are needed for conducting rigorous observational studies to help recruit patients in multicenter, randomized controlled trials. In the absence of comparative evidence, the CHEST expert cough panel will extrapolate indirect evidence and incorporate the existing evidence base with patients’ values, preferences, clinical context, and availability of therapies to guide patient care. The uncertainty in the evidence should be conveyed to patients at the point of decision-making.

Only low-quality evidence exists to support a particular strategy to define, diagnose, and treat psychogenic, habit, and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.

Author contributions: Q. H. is the guarantor and takes full responsibility for the accuracy and integrity of the data in this manuscript. Q. H., F. A., M. F., and P. B. contributed to screening of abstracts and full texts and data extraction; Q. H. and M. H. M. contributed to drafting of the manuscript; Q. H., F. A., M. F., P. B., A. E. V., P. A. N., T. P., A. B. C., B. K. R., L. M., K. A. W., K. W. A., A. F., M. H. M., and R. S. I. contributed to critical revision of the manuscript for important intellectual content.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: In the last 3 years, Dr Altman was a consultant for Nestlé SA and Watermark Research Partners Inc (for Stryker Corp). He has no conflict of interest in the last 22 months. Because Dr Irwin is the Editor in Chief of the Journal, as well as an author on this article, he reports that he did not participate in the Journal’s review and decision process of the article. All other authors have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Additional information: The e-Appendix can be found in the Supplemental Materials section of the online article.

CHEST

American College of Chest Physicians

DSM

Diagnostic and Statistical Manual of Mental Disorders

Boulet L-P. The current state of cough research: the clinician’s perspective. Lung. 2008;186(suppl 1):S17-S22. [CrossRef] [PubMed]
 
Irwin RS. Introduction to the diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):25S-27S. [CrossRef] [PubMed]
 
Irwin RS, Boulet L-P, Cloutier MM, et al. Managing cough as a defense mechanism and as a symptom: a consensus panel report of the American College of Chest Physicians. Chest. 1998;114(2_suppl):133S-181S. [CrossRef] [PubMed]
 
Schappert SM, Nelson C. National Ambulatory Medical Care Survey: 1995-96 summary. Vital Health Stat 13. 1999;;(142):1-122.
 
McGarvey LP, Polley L, MacMahon J. Common causes and current guidelines. Chron Respir Dis. 2007;4(4):215-223. [CrossRef] [PubMed]
 
Iyer VN, Lim KG. Chronic cough: an update. Mayo Clin Proc. 2013;88(10):1115-1126. [CrossRef] [PubMed]
 
Pratter MR. Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):59S-62S. [CrossRef] [PubMed]
 
Haque RA, Usmani OS, Barnes PJ. Chronic idiopathic cough: a discrete clinical entity? Chest. 2005;127(5):1710-1713. [CrossRef] [PubMed]
 
Weinberg EG. ‘Honking’: Psychogenic cough tic in children. S Afr Med J. 1980;57(6):198-200. [PubMed]
 
Mastrovich JD, Greenberger PA. Psychogenic cough in adults: a report of two cases and review of the literature. Allergy Asthma Proc. 2002;23(1):27-33. [PubMed]
 
Bhatia MS, Chandra R, Vaid L. Psychogenic cough: a profile of 32 cases. Int J Psychiatry Med. 2002;32(4):353-360. [CrossRef] [PubMed]
 
Wagner JB, Pine HS. Chronic cough in children. Pediatr Clin North Am. 2013;60(4):951-967. [CrossRef] [PubMed]
 
Holinger LD, Sanders AD. Chronic cough in infants and children: an update. Laryngoscope. 1991;101(6 pt 1):596-605. [PubMed]
 
Weinberger M. The habit cough syndrome and its variations. Lung. 2012;190(1):45-53. [CrossRef] [PubMed]
 
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. [CrossRef] [PubMed]
 
Irwin RS, Glomb WB, Chang AB. Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):174S-179S. [CrossRef] [PubMed]
 
Pringsheim T, Doja A, Gorman D, et al. Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. Can J Psychiatry. 2012;57(3):133-143. [PubMed]
 
Steeves T, McKinlay BD, Gorman D, et al. Canadian guidelines for the evidence-based treatment of tic disorders: behavioural therapy, deep brain stimulation, and transcranial magnetic stimulation. Can J Psychiatry. 2012;57(3):144-151. [PubMed]
 
Wells GASB, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. Quality Assessment Scales for Observational Studies. Ottawa, ON, Canada: Ottawa Health Research Institute; 2004.
 
Anbar RD, Hall HR. Childhood habit cough treated with self-hypnosis. J Pediatr. 2004;144(2):213-217. [CrossRef] [PubMed]
 
Cohlan SQ, Stone SM. The cough and the bedsheet. Pediatrics. 1984;74(1):11-15. [PubMed]
 
Anbar RD. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr. 2002;2:11. [CrossRef] [PubMed]
 
Anbar RD, Hummell KE. Teamwork approach to clinical hypnosis at a pediatric pulmonary center. Am J Clin Hypn. 2005;48(1):45-49. [CrossRef] [PubMed]
 
Berman BA. Habit cough in adolescent children. Ann Allergy. 1966;24(1):43-46. [PubMed]
 
Lavigne JV, Davis AT, Fauber R. Behavioral management of psychogenic cough: alternative to the “bedsheet” and other aversive techniques. Pediatrics. 1991;87(4):532-537. [PubMed]
 
Lokshin B, Lindgren S, Weinberger M, Koviach J. Outcome of habit cough in children treated with a brief session of suggestion therapy. Ann Allergy. 1991;67(6):579-582. [PubMed]
 
Bernztein R, Grenoville M. Chronic cough in pediatrics [in Spanish]. Medicina (B Aires). 1995;55(4):324-328. [PubMed]
 
Bordoy A, Sardón O, Mayoral JL, Garay J, Mintegui J, Pérez-Yarza EG. Psychogenic cough: another etiology for persistent cough [in Spanish]. An Pediatr (Barc). 2004;61(1):62-65. [CrossRef] [PubMed]
 
Kravitz H, Gomberg RM, Burnstine RC, Hagler S, Korach A. Psychogenic cough tic in children and adolescents. Nine case histories illustrate the need for re-evaluation of this common but frequently unrecognized problem. Clin Pediatr (Phila). 1969;8(10):580-583. [CrossRef] [PubMed]
 
Shuper A, Mukamel M, Mimouni M, Lerman M, Varsano I. Psychogenic cough. Arch Dis Child. 1983;58(9):745-747. [CrossRef] [PubMed]
 
Blager FB, Gay ML, Wood RP. Voice therapy techniques adapted to treatment of habit cough: a pilot study. J Commun Disord. 1988;21(5):393-400. [CrossRef] [PubMed]
 
Gay M, Blager F, Bartsch K, Emery CF, Rosenstiel-Gross AK, Spears J. Psychogenic habit cough: review and case reports. J Clin Psychiatry. 1987;48(12):483-486. [PubMed]
 
Kastelik JA, Aziz I, Ojoo JC, Thompson RH, Redington AE, Morice AH. Investigation and management of chronic cough using a probability-based algorithm. Eur Respir J. 2005;25(2):235-243. [CrossRef] [PubMed]
 
Sipp JA, Haver KE, Masek BJ, Hartnick CJ. Botulinum toxin A: a novel adjunct treatment for debilitating habit cough in children. Ear Nose Throat J. 2007;86(9):570-572. [PubMed]
 
Tan H, Büyükavci M, Arik A. Tourette’s syndrome manifests as chronic persistent cough. Yonsei Med J. 2004;45(1):145-149. [PubMed]
 
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-406. [CrossRef] [PubMed]
 
Power JT, Stewart IC, Connaughton JJ, et al. Nocturnal cough in patients with chronic bronchitis and emphysema. Am Rev Respir Dis. 1984;130(6):999-1001. [PubMed]
 
Mello CJ, Irwin RS, Curley FJ. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med. 1996;156(9):997-1003. [CrossRef] [PubMed]
 
American Psychiatric Association. Diagnostic criteria from DSM5. Washington, DC: American Psychiatric Publishing; 2013.
 
American Psychiatric Association. Diagnostic criteria from DSM-IV. Washington, DC: American Psychiatric Publishing; 1994.
 
Pratter MR. Unexplained (idiopathic) cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):220S-221S. [CrossRef] [PubMed]
 

Tables

Table Graphic Jump Location
TABLE 1  ] Characteristics of Included Studiesa

NR = not reported.

a 

All included studies were retrospective and uncontrolled.

b 

Both Blager et al31 and Gay et al32 reported treating the same four patients. Therefore, we included only Blager et al31 and extracted data from both.

Table Graphic Jump Location
TABLE 2  ] Cough Characteristics

URI = upper respiratory tract infection.

Table Graphic Jump Location
TABLE 3  ] Methodologic Quality Indicators
Table Graphic Jump Location
TABLE 4  ] Nonpharmacologic Interventions
a 

This represents patients’ percent of the total 223 patients.

Table Graphic Jump Location
TABLE 5  ] Effects of Interventions

References

Boulet L-P. The current state of cough research: the clinician’s perspective. Lung. 2008;186(suppl 1):S17-S22. [CrossRef] [PubMed]
 
Irwin RS. Introduction to the diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):25S-27S. [CrossRef] [PubMed]
 
Irwin RS, Boulet L-P, Cloutier MM, et al. Managing cough as a defense mechanism and as a symptom: a consensus panel report of the American College of Chest Physicians. Chest. 1998;114(2_suppl):133S-181S. [CrossRef] [PubMed]
 
Schappert SM, Nelson C. National Ambulatory Medical Care Survey: 1995-96 summary. Vital Health Stat 13. 1999;;(142):1-122.
 
McGarvey LP, Polley L, MacMahon J. Common causes and current guidelines. Chron Respir Dis. 2007;4(4):215-223. [CrossRef] [PubMed]
 
Iyer VN, Lim KG. Chronic cough: an update. Mayo Clin Proc. 2013;88(10):1115-1126. [CrossRef] [PubMed]
 
Pratter MR. Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):59S-62S. [CrossRef] [PubMed]
 
Haque RA, Usmani OS, Barnes PJ. Chronic idiopathic cough: a discrete clinical entity? Chest. 2005;127(5):1710-1713. [CrossRef] [PubMed]
 
Weinberg EG. ‘Honking’: Psychogenic cough tic in children. S Afr Med J. 1980;57(6):198-200. [PubMed]
 
Mastrovich JD, Greenberger PA. Psychogenic cough in adults: a report of two cases and review of the literature. Allergy Asthma Proc. 2002;23(1):27-33. [PubMed]
 
Bhatia MS, Chandra R, Vaid L. Psychogenic cough: a profile of 32 cases. Int J Psychiatry Med. 2002;32(4):353-360. [CrossRef] [PubMed]
 
Wagner JB, Pine HS. Chronic cough in children. Pediatr Clin North Am. 2013;60(4):951-967. [CrossRef] [PubMed]
 
Holinger LD, Sanders AD. Chronic cough in infants and children: an update. Laryngoscope. 1991;101(6 pt 1):596-605. [PubMed]
 
Weinberger M. The habit cough syndrome and its variations. Lung. 2012;190(1):45-53. [CrossRef] [PubMed]
 
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. [CrossRef] [PubMed]
 
Irwin RS, Glomb WB, Chang AB. Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):174S-179S. [CrossRef] [PubMed]
 
Pringsheim T, Doja A, Gorman D, et al. Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. Can J Psychiatry. 2012;57(3):133-143. [PubMed]
 
Steeves T, McKinlay BD, Gorman D, et al. Canadian guidelines for the evidence-based treatment of tic disorders: behavioural therapy, deep brain stimulation, and transcranial magnetic stimulation. Can J Psychiatry. 2012;57(3):144-151. [PubMed]
 
Wells GASB, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. Quality Assessment Scales for Observational Studies. Ottawa, ON, Canada: Ottawa Health Research Institute; 2004.
 
Anbar RD, Hall HR. Childhood habit cough treated with self-hypnosis. J Pediatr. 2004;144(2):213-217. [CrossRef] [PubMed]
 
Cohlan SQ, Stone SM. The cough and the bedsheet. Pediatrics. 1984;74(1):11-15. [PubMed]
 
Anbar RD. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr. 2002;2:11. [CrossRef] [PubMed]
 
Anbar RD, Hummell KE. Teamwork approach to clinical hypnosis at a pediatric pulmonary center. Am J Clin Hypn. 2005;48(1):45-49. [CrossRef] [PubMed]
 
Berman BA. Habit cough in adolescent children. Ann Allergy. 1966;24(1):43-46. [PubMed]
 
Lavigne JV, Davis AT, Fauber R. Behavioral management of psychogenic cough: alternative to the “bedsheet” and other aversive techniques. Pediatrics. 1991;87(4):532-537. [PubMed]
 
Lokshin B, Lindgren S, Weinberger M, Koviach J. Outcome of habit cough in children treated with a brief session of suggestion therapy. Ann Allergy. 1991;67(6):579-582. [PubMed]
 
Bernztein R, Grenoville M. Chronic cough in pediatrics [in Spanish]. Medicina (B Aires). 1995;55(4):324-328. [PubMed]
 
Bordoy A, Sardón O, Mayoral JL, Garay J, Mintegui J, Pérez-Yarza EG. Psychogenic cough: another etiology for persistent cough [in Spanish]. An Pediatr (Barc). 2004;61(1):62-65. [CrossRef] [PubMed]
 
Kravitz H, Gomberg RM, Burnstine RC, Hagler S, Korach A. Psychogenic cough tic in children and adolescents. Nine case histories illustrate the need for re-evaluation of this common but frequently unrecognized problem. Clin Pediatr (Phila). 1969;8(10):580-583. [CrossRef] [PubMed]
 
Shuper A, Mukamel M, Mimouni M, Lerman M, Varsano I. Psychogenic cough. Arch Dis Child. 1983;58(9):745-747. [CrossRef] [PubMed]
 
Blager FB, Gay ML, Wood RP. Voice therapy techniques adapted to treatment of habit cough: a pilot study. J Commun Disord. 1988;21(5):393-400. [CrossRef] [PubMed]
 
Gay M, Blager F, Bartsch K, Emery CF, Rosenstiel-Gross AK, Spears J. Psychogenic habit cough: review and case reports. J Clin Psychiatry. 1987;48(12):483-486. [PubMed]
 
Kastelik JA, Aziz I, Ojoo JC, Thompson RH, Redington AE, Morice AH. Investigation and management of chronic cough using a probability-based algorithm. Eur Respir J. 2005;25(2):235-243. [CrossRef] [PubMed]
 
Sipp JA, Haver KE, Masek BJ, Hartnick CJ. Botulinum toxin A: a novel adjunct treatment for debilitating habit cough in children. Ear Nose Throat J. 2007;86(9):570-572. [PubMed]
 
Tan H, Büyükavci M, Arik A. Tourette’s syndrome manifests as chronic persistent cough. Yonsei Med J. 2004;45(1):145-149. [PubMed]
 
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-406. [CrossRef] [PubMed]
 
Power JT, Stewart IC, Connaughton JJ, et al. Nocturnal cough in patients with chronic bronchitis and emphysema. Am Rev Respir Dis. 1984;130(6):999-1001. [PubMed]
 
Mello CJ, Irwin RS, Curley FJ. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med. 1996;156(9):997-1003. [CrossRef] [PubMed]
 
American Psychiatric Association. Diagnostic criteria from DSM5. Washington, DC: American Psychiatric Publishing; 2013.
 
American Psychiatric Association. Diagnostic criteria from DSM-IV. Washington, DC: American Psychiatric Publishing; 1994.
 
Pratter MR. Unexplained (idiopathic) cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):220S-221S. [CrossRef] [PubMed]
 
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