MONTREAL — When treating habit cough, one should avoid steroids and consider potential psychological stressors, Dr. Louis Landau said at the Seventh International Congress on Pediatric Pulmonology.
Habit cough is a rare diagnosis in adults, but studies suggest it is made in 3%–10% of children with cough of unknown origin that persists for more than 1 month. It frequently results in extended school absences and multiple therapeutic trials, including high-dose steroids.
It is not the typical cough seen in children, and is often described as sounding like the honk of a Canada goose.
“It's a very loud, dry bark,” said Dr. Landau, emeritus professor and former dean, faculty of medicine and dentistry, University of Western Australia in Crawley.
Although this bizarre sound is alarming to those around the coughing child, the child is generally not perturbed by it.
Another clinical feature is that it is the only type of cough that goes away when the child sleeps, he said.
Dr. Landau said there often is evidence of stress in these patients, but that is not to suggest they have major psychological problems. They are frequently high-achieving children under a lot of pressure to perform either in school or sports.
The typical duration of a habit cough is difficult to define because diagnosis frequently is made after several referrals, making the origin of the cough difficult to pinpoint. The literature is not consistent in its definition of habit cough, and most studies haven't differentiated among habit coughs, tics, and Tourette's syndrome.
On rare occasions, habit cough may be a manifestation of a tic disorder or symptom of Tourette's syndrome, but it is uncommon, Dr. Landau said.
The American College of Chest Physicians recently published evidence-based clinical practice guidelines for habit cough, tic cough, and psychogenic cough in adult and pediatric populations (Chest 2006;129:174S-9S).
The good news, Dr. Landau explained, is that treatment is very effective after the diagnosis is made and explained to the parents. Habit cough is generally managed by exclusion of organic disease, reassurance, addressing any identified stressors, and breathing-control exercises, he added.
Habit cough is often evidence of stress. It is often present in high-achieving children who are under a lot of pressure. DR. LANDAU