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Consider stress and avoid steroids in treating habit cough.

MONTREAL -- When treating habit cough, 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. "You can hear it from out in the waiting room; 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.

It's unlikely that adults would produce the same characteristic bark because they can't compress their trachea to the same degree as children, the physician said.

Although this bizarre sound is alarming to those around them, the coughing children are strangely unperturbed by it. Another clinical feature is that it is the only cough that really goes away when the child sleeps, he said.

There often is eyidence 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, he said.

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 once 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.

"The important thing is not to fall into the trap of using high-dose steroids, which often occurs with these children," he said.

During the audience discussion session, Dr. Miles Weinberger said he has successfully treated habit cough with "suggestion therapy."

The therapy combined positive feedback with asking patients to perform an alternative behavior such as sipping warm water or inhaling a mist for 15 minutes while focusing on suppressing the urge to cough (Ann. Allergy 1991;67:579-82).

"At 2-year follow-up, there were no recurrences they couldn't handle on their own," said Dr. Weinberger, director of the pediatric allergy and pulmonary division, University of Iowa, Iowa City.

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Title Annotation:Clinical Rounds
Author:Wendling, Patrice
Publication:Pediatric News
Date:Oct 1, 2006
Words:480
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