Interactive Quiz: Chronic Cough in a Child
Welcome to Pulmonology Consultant's latest interactive diagnostic quiz. Over the next few pages, we'll present a case and ask you to make the diagnosis and treat the patient. Along the way, we'll provide details about the case, and at the end, we'll share the patient's outcome.
Ready to get started? >>
First, let’s meet the patient…
A 9-year-old girl had had a chronic cough interspersed with periods of relief for more than 2 years. She had no fever or history of other medical problems. The cough was loud and was described as sounding like a barking dog. The girl would sometimes cough for 18 hours straight. Because of the cough, she had frequently missed school, had had more than 20 visits to 3 different hospital emergency departments, and had seen 2 pediatricians, 3 otolaryngologists, 2 speech therapists, and 1 pediatric pulmonary specialist. Multiple diagnostic tests had identified no cause for her chronic cough.
She had been treated with bronchodilators and several antibiotics and had gained excessive weight from having been prescribed corticosteroids. These treatments had had no effect on her cough. She had been hospitalized once to sedate her in an unsuccessful attempt to stop the coughing.
Are you correct? >>
Answer: Seek psychiatric help
The patient’s pulmonologist had recommended psychiatric help, which had been of no benefit.
At presentation, the girl’s cough was present from when she wakes up until she falls asleep. Once asleep, she does not cough. She had headaches and chest soreness from the forceful nature of the coughing. She loves school, does well there, has friends, and her only source of anxiety was the cough.
Are you correct? >>
Answer: Habit cough
Based on the clinical presentation, the girl received a diagnosis of habit cough.
An algorithmic approach begins with a diagnosis that can be made just on the clinical presentation and proceeds to specific noninvasive tests. More invasive tests, such as bronchoscopy, are necessary when causes of the cough are not identified from those initial measures.
However, in this patient’s case, the diagnosis is apparent from the clinical presentation. A chronic, harsh, repetitive, barking cough that is absent once the child is asleep is diagnostic of the habit cough syndrome.
Are you correct? >>
Answer: Have the girl undergo suggestion therapy
Suggestion therapy was instructed in a manner illustrated at www.habitcough.com via Skype video conferencing because of the 3000 miles between the patient and the physician providing suggestion instruction. The suggestion therapy involved having the patient focus on listening to a continuous patter explaining habit cough, encouraging the patient to hold back the cough for a defined period of time that progressively expanded, and empowering the patient to break the cycle of cough causing more cough by the end of the 15-minute session.
Positive support for initial success was given, with emphasis on confidence that the patient could attain continued prevention of cough. This was followed by autosuggestion instruction, expressing confidence that the patient could do the same thing on her own if there were any tendency for the cough to return.
After suggestion therapy, the girl’s harsh repetitive coughing stopped. She continued to have the urge to cough for another day or 2 but generally controlled it, and she continues to be free of cough to the present.
Are you correct? >>
Answer: Yes
The mean age for this disorder has been identified as 10 years at 3 institutions: the University of Iowa; the Mayo Clinic in Rochester, Minnesota; and Royal Brompton Hospital in London, England. Eighty-five percent of 120 children at a University of Iowa program were between 8 and 14 years of age.
Habit cough is not rare, with an average of 7 cases per year seen at the University of Iowa and 9 per year seen at the Royal Brompton Hospital in London.
To read the full case report, see:
Weinberger M. Habit cough [published online April 10, 2019]. Pulmonology Consultant. https://www.consultant360.com/article/pulmonology/habit-cough.