Management and diagnosis of psychogenic cough, habit cough, and tic cough: a systematic review.
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.
Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN. Electronic address: q.haydour@gmail.com.
Qusay
Q
Haydour
Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN.
Fares
F
Alahdab
Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN.
Magdoleen
M
Farah
Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN.
Patricia
P
Barrionuevo
John Hunter Hospital, Department of Speech Pathology, Newcastle, NSW, Australia.
Anne E
AE
Vertigan
University of Queensland, School of Psychology, Brisbane, QLD, Australia.
Peter A
PA
Newcombe
University of Calgary, Calgary, AB, Canada.
Tamara
T
Pringsheim
Royal Children's Hospital and Menzies School of Health Research, Charles Darwin University, Brisbane, Brisbane, QLD, Australia.
Anne B
AB
Chang
Children's Hospital of Richmond and Virginia Commonwealth University, Richmond, VA.
Bruce K
BK
Rubin
Centre for Infection and Immunity, The Queen's University of Belfast, Belfast, Northern Ireland.
Lorcan
L
McGarvey
Royal Children's Hospital Department of Speech Pathology and Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia.
Kelly A
KA
Weir
Mount Sinai Hospital, New York, NY.
Kenneth W
KW
Altman
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Anthony
A
Feinstein
Mayo Clinic, The Knowledge and Evaluation Research Unit and the Center for the Science of Health Care Delivery, Rochester, MN.
Mohammad Hassan
MH
Murad
UMass Memorial Medical Center, Worcester, MA.
Richard S
RS
Irwin
D000529:Complementary Therapies / Q000379:methods*; D003371:Cough / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D006184:Habits; D006801:Humans; D017410:Practice Guidelines as Topic; D013981:Tic Disorders / Q000150:complications*; D020323:Tics / Q000503:physiopathology / Q000523:psychology*