Management and Diagnosis of Psychogenic Cough, Habit Cough, and Tic Cough: A Systematic Review.

SESSION TITLE: Pediatric Medicine PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Several pharmacological and non-pharmacological therapeutic options have been used to treat psychogenic cough, habit cough and tic cough. The American College of Chest Physicians (ACCP) develops clinical practice guidelines to help patients and physicians in decision-making. To aid the development of guidelines for these challenging conditions, we conducted a systematic review of the available literature on the management of psychogenic cough, habit cough and tic cough.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% males, 96% children and adolescent). Psychogenic cough was the most common descriptive term used (90% of the studies). 95% of the patients had no cough during sleep; barking or honking quality to cough was described in only 8 studies. Hypnosis (3 studies), suggestion therapy (4 studies), and counseling and reassurance (7 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.CLINICAL IMPLICATIONS: 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 multi-center randomized controlled trials. The uncertainty in the evidence should be conveyed to patients at the point of decision making.DISCLOSURE: The following authors have nothing to disclose: Qusay Haydour, Fares Alahdab, Magdoleen Farah, Patricia Barrionuevo Moreno, Anne Vertigan, Peter Newcombe, Tamara Pringsheim, Anne Chang, Bruce Rubin, Lorcan McGarvey, Kelly Weir, Kenneth Altman, Anthony Feinstein, Mohammad Hassan Murad, Richard IrwinNo Product/Research Disclosure Information.