The Habit Cough Syndrome and Its Variations by Dr. Miles Weinberger, MD

21 min readApr 2, 2022

By Dennis and Bethany Buettner

Updated from the original 2011 paper by Dr. Miles Weinberger, MD. Refractory Unexplained Chronic Cough (RUCC) Diagnosed as the Habit Cough Syndrome Can Be Instantly & Permanently Cured in Minutes ~ or Even Seconds, In Children and Adults ~ Simply by Watching a peer reviewed and published YouTube Documentary Video (or via Telemedicine)

Video repository of Dr. Weinberger’s research HERE
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Peer Reviewed and Published Accidental Medical Discovery by Dr. Miles Weinberger, MD, University of Iowa. All pertinent medical research has been peer reviewed and published since Hippocrates. (Not intended to be medical advice. Consult with your doctor for your medical concerns. There is no medical advice in this story.)

[Medical White Paper] The Habit Cough Syndrome and Its Variations — Adult & Child Cures Via-telemedicine & By-proxy

Editor note: Please refer to www.HabitCough.com for updated research and outcomes regarding cures via-telemedicine, in-office and by-proxy via watching a YouTube documentary.

by Dr. Miles Weinberger, MD

Received: 3 July 2011 / Accepted: 25 July 2011 / Published online: 13 August 2011

Springer Science+Business Media, LLC 2011

Abstract Involuntary cough without an identified underlying

organic reason has been given various names and

recommended treatments. Current experience suggests that

‘‘habit cough’’ best describes this entity. Suggestion therapy

in its various forms is the treatment of choice. Successful

therapy is directed at demonstrating to the patient that he/she

has the ability to resist the urge to cough. Attempts at

medical treatment or use of placebo therapy, even with the

suggestion that the ‘‘medicine’’ will stop the cough, are

generally not successful. Continued symptoms for years can

occur in the absence of suggestion therapy. Sustained

relapse after suggestion therapy is uncommon.

Background

Involuntary cough without an identified underlying organic

reason has been repeatedly described. One of the earliest

detailed case reports accompanied by 1 year of follow-up

was published by Bernstein [1]. He described a 12-year-old

girl with what he named ‘‘the barking cough of puberty.’’

Two months later Baker [2] placed ‘‘chronic cough from

habit or psychosomatic disease’’ in the differential diagnosis

for chronic cough in children. The actual term ‘‘habit

cough’’ was first used by Berman in 1966 [3]. He reported

on six children (three in detail) with whom he ‘‘relied

solely on the art of suggestion’’ to produce the cessation of

cough. His 2-year follow-up supported the success of his

therapy. Since then several descriptive terms has been used

for this condition: ‘‘functional or psychogenic cough’’ [4],

‘‘psychogenic cough tic’’ [5], ‘‘operant cough’’ [6],

‘‘honking’’ [7], and ‘‘involuntary cough syndrome’’ [8].

Clinical Characteristics of the Classic Habit Cough

In 1991, we first reported our experience with the classic

habit cough syndrome [9], describing the following

15-year-old girl:

Case 1: She had been coughing multiple times per

minute during the clinic visit. The cough was the

characteristic harsh tracheal cough sounding like a

‘‘barking dog’’ or ‘‘barking seal.’’ She had experienced

this intractable coughing for many months, had

been subjected to extensive medical evaluation, and

had experienced no consistent response even to several

hospitalizations. Although interfering with getting

to sleep, parents observed no cough at all during

sleep nor had cough ever awakened her once asleep.

She had been a good student with many friends and

expressed regret about missing school because the

cough made attending class unacceptably intrusive.

The cough was stopped by me during a 15-minute

course of suggestion therapy in a manner used previously

in similar cases.

In that report [9], we identified nine patients with habit

cough, all initially misdiagnosed as asthma. I or one of my

colleagues had treated each of them during a period of

sustained repetitive symptoms with a brief session of

suggestion therapy. Symptoms had previously been present

for up to 2 years (median of 2 months). Five had been

hospitalized for the cough. Evaluation revealed no physiologic

or radiologic abnormality. All patients became

symptom-free during a 15-min session of suggestion therapy.

During the subsequent week, one remained completely

asymptomatic and 8 had transient minor relapses

that were readily self-controlled by our autosuggestion

instructions. Seven of the nine could be contacted for

determination of long-term outcome at periods up to

9 years (median = 2.2 years) after the session. Six were

totally asymptomatic; one had occasional minor self-controlled

symptoms.

In a review of the literature, 153 patients in 17 publications

were identified with sufficient descriptive detail

[10]. Of those, 149 were younger than 18 years and the

other four patients were adult women from 19 to 30 years

of age. Several clinical characteristics of habit cough

(Table 1) have been described with striking similarity by

all authors despite some differences in diagnostic approach.

Habit cough occurred only slightly more often in females

than in males. Ages have ranged from 5 to 30 years, but the

vast majority of patients were teenagers. The duration of

cough prior to diagnosis ranged from 1 week to 16 years,

with the median duration for each report from weeks to

months for children and 4 years for adults.

All case reports noted a predominantly daytime cough

that disappeared after patients actually fell asleep. The

cough was described as dry, repetitive, generally nonproductive,

‘‘barking seal,’’ loud cough that would increase

whenever attention was being paid to it. In contrast to

organic causes of cough, increase with exercise was not

noted, nor would the cough awaken the patient once asleep.

Nineteen pediatric patients and all four adults experienced

prior diagnoses of asthma. These diagnoses were disproved

during the evaluation that resulted in the diagnosis of habit

cough. An initial respiratory insult such as a viral respiratory

infection, trauma to the airways, or a severe allergic

reaction with respiratory manifestations was identified in

35% (56 of 153) of the patients.

For most, multiple radiological, serological, clinical,

pulmonary functions, and endoscopic evaluations invariably

showed negative results. The exceptions are the

reports of localized tracheomalacia found by flexible

bronchoscopy in seven patients [11]. Five of seven were

treated with hypnosis with sustained improvement, suggesting

that a habit-like component had been acquired in

these patients predisposed to irritating their tracheas due to

the structural instability at the site of the malacia. However,

the significant nocturnal cough in those patients with

tracheomalacia distinguished them from other typical cases

of habit cough. Lavigne et al. [12] also reported localized

bronchomalacia due to vascular compression of the right

main bronchus in one case [12].

‘‘Chin-to-chest’’ posture or some stereotypical ‘‘handsto-

mouth’’ gestures accompanying the cough were

described by some authors [1, 7, 13, 14]. The physical

examination was generally normal. However, several

authors did report some specific physical findings [4, 11,

12, 15, 16]. Cohlan and Stone [15] checked the gag and

corneal reflexes in 31 patients with habit cough and found

abnormally decreased or absent gag reflex in all and

depressed or absent corneal reflex in 21. Rabin [4]

brought attention to the ‘‘presence of edema of the lingual

tonsils’’ that ‘‘impinge on the epiglottis, obliterating the

vallecula space.’’ In his view, this was the result of the

severe cough itself. Cohlan and Stone [15] and then Wolff

[14] reported patients’ ability to reproduce the paroxysm

of cough on command, but our own experience was to the

contrary.

Psychopathologic Associations

The degree to which psychological abnormalities are

responsible for or even present in habit cough is controversial.

The extent of evaluation for possible psychological

problems associated with habit cough reported in the literature

varied from office interviews done by the allergist

or pulmonologist (for most) to extended psychiatric evaluations

done by a psychologist or a psychiatrist. Whether

specific patients were referred for psychological evaluation

appeared to depend on the author’s conception of the origin

of this illness. Overall, school phobias, secondary gain, or

significant psychological conflicts were reported in 34 of

153 patients. All four adults were reported to meet the

criteria for conversion reactions or somatization with

conversional symptoms [17, 18]. The contrast between

those studies that found some sort of psychological problem

to be present in (and responsible for) the habit cough

phenomenon in all or almost all of their patients [5, 7, 13,

19], and those that found no significant psychological

problems among their patients suggests either marked

differences in patient selection or biases of the observers

[3, 15]. Only 1 of 33 patients of Cohlan and Stone [15] was

reported to need psychiatric treatment for a significant

conversion disorder. Berman [3] suspected school phobia

in only one of his six patients. None of the nine patients we

previously reported with habit cough had identifiable psychological

or psychiatric problems. Moreover, follow-up

with a standardized psychological questionnaire (SCL-90-R)

did not reveal any apparent somatization or other psychopathology

in any of our patients, although they did score

somewhat higher than usual norms on an obsessive-compulsive

scale [9]. It was also our clinical observations that

they were brighter than average, with generally excellent

school performance.

Prevalence

The prevalence of habit cough is difficult to establish.

Eighteen years of clinical experience from Mayo Clinic

reported only 62 cases of habit cough diagnoses [8].

Cohlan and Stone [15] reported 33 cases of habit cough

from over 25 years of his clinical experience. Later Wolff

[14], from the same clinic, described another two patients

and mentioned a total of six over the next 4 years after the

original report. Houstek et al. [19] reported ten cases from

1971 to 1981. In our own retrospective study of close to

4,500 medical records from a pediatric allergy and pulmonary

referral service covering more than 12 years, we

identified 23 patients with all categories of functional

respiratory disorders, of whom 9 had habit cough (Table 2)

[9]. Although habit cough was the most frequent diagnosis

in that report, this probably reflects more the severity and

duration of symptoms of habit cough compared with some

of the other diagnoses in Table 2 rather than the true relative

incidence in the community; we suspect that hyperventilation

attacks, for example, are much more common

than indicated in Table 2 because of the greater recognition

in the community and lesser likelihood of referral to our

subspecialty service. From our personal observations and

communications with our colleagues, it seems that busy

specialists would encounter about one to two cases of habit

cough a year. It is probably underreported and underestimated

because of the lack of a clear definition and specific

diagnostic tests and because of the low awareness of it in

the general medical community.

Variations of the Habit Cough Syndrome

A Common Variation of the Habit Cough Syndrome:

Habit Throat Clearing

Case 2: A 6 y.o. boy has been having a repeated

throat clearing cough for several weeks following

initial symptoms consistent with a viral upper respiratory

infection. Unlike the barking cough described

in Case 1, this was characterized by a much softer

sound appearing to be somewhere between a cough

and throat clearing. Similar to Case 1, the sound was

repetitive occurring up to several times per minute

during waking hours but was absent once asleep. A

15 minute session of suggestion therapy was successful

in stopping the repetitive activity.

This variation of the habit cough, perhaps better termed

habit throat clearing (although parents frequently refer to

this as coughing), tends to generate less concern because of

its milder nature. It is nonetheless annoying to those around

the patient, especially the parents, though less bothersome

to the individual manifesting this disorder.

Less common variations that I have seen include habit

sniffing, habit nose blowing, and habit sneezing (Table 2).

All of these are characterized by the repetitive nature of the

behaviors that are completely absent once asleep. All

responded to suggestion therapy by the faculty of the

Pediatric Allergy and Pulmonary Division.

Differential Diagnostic Considerations

Asthma

Cough is certainly a prominent symptom of asthma,

occurring as frequently as the wheezing that characterizes

asthma. However, the cough of asthma is characteristically

made worse with activity and, in contradistinction to the

habit cough, occurs during sleep; the individual with a

cough from asthma is frequently awakened by cough.

Airway Malacia

Both tracheomalacia (Fig. 1) and bronchomalacia (Fig. 2)

have previously been described as being misdiagnosed as

asthma [20]. Inadequate rigidity of the tracheal or mainstem

bronchial cartilage results in collapse which causes

cough by at least two mechanisms. Collapse of the trachea

or mainstem bronchi during increased intrathoracic pressure

as in vigorous exhalation or coughing can cause the

anterior and posterior walls to come into contact resulting

in an irritable focus that stimulates further cough. Additionally,

when secretions are present in the airway, the

airway collapse during expiration prevents normal airway

clearance of mucus. The secretions then act as a further

stimulus for cough. While tracheomalacia and bronchomalacia

can be troublesome in the infant, some cases do

not cause problems until later in childhood [11].

Protracted Bacterial Bronchitis

This is an entity not well appreciated and only infrequently

described with various descriptive terms [21–24]. While

chronic bacterial bronchitis is certainly a characteristic of

cystic fibrosis, protracted bacterial bronchitis occurs predominantly

in young children with no identifiable abnormalities

of immunity or other underlying disease. They

have prolonged periods of cough with neutrophilia and

high colony counts of bacteria in their lower airways

demonstrable by bronchoalveolar lavage. A predominance

of tracheal and bronchial malacia has been associated

with protracted bacterial bronchitis [25]. Those abnormalities

may be contributing to both cough and retention

of secretions in the lower airway which predisposes the

child to secondary infection. These patients are readily

distinguished from the habit cough by the young age and

troublesome cough at night that frequently disturbs sleep.

Pertussis (Whooping Cough)

Infection from Bordetella pertussis, known in the past as

the 100-day cough, causes a prolonged period of cough,

and we have seen several cases where the primary care

physician prescribed antiasthmatic medication because

pertussis was not adequately considered. While the cough

is characteristically spasmodic and associated with posttussive

gagging or emesis, the classical clinical symptoms

of a whoop are often not present in an immunized population.

In fact, evidence for B. pertussis infection in

immunized children and adults has been persistent cough

for two or more weeks in the absence of a prior history

consistent with an underlying disorder [26–30]. Establishing

the diagnosis is important to prevent spread to contacts,

especially to young infants who are at the greatest risk for

hospitalization and fatality from this infection. Diagnosis is

most readily made by polymerase chain reaction (PCR)

identification of the pertussis antigen from a properly

collected nasal swab. As with other causes of organic

cough, cough generally disturbs sleep, in contrast to the

functional habit cough that is characteristically absent once

the individual is asleep,

Pseudoconsiderations

Prolonged cough has also been frequently attributed to

gastroesophageal reflux (GER). However, data have not

been supportive of GER as an etiology of respiratory

symptoms [31, 32]. When children with GER and cough

have been examined for inflammation in the lower airway, it

was protracted bacterial bronchitis and not reflux that was

associated with the cough [33, 34]. When studied, GER itself

has not been associated with increased airway inflammation

[33]. Similarly, sinusitis and postnasal drainage cannot be

argued as a cause of prolonged cough without having evidence

of the absence of protracted bacterial bronchitis as the

etiology for simultaneous inflammation of the upper and

lower airways [35]. These two popular pseudodiagnoses

should not be confused with habit cough, with its repetitive

pattern and absence once asleep.

Treatment

Even when habit cough is correctly diagnosed, absence of a

specific treatment plan can result in prolonged symptomatology.

In a report of 60 patients from the Mayo Clinic, 44

required an average of 6 months beyond the diagnosis for

resolution and 16 continued to be symptomatic (mean

duration of 5.9 years) [8]. The therapeutic approaches

reported in the literature can be divided into two major

groups: (1) vigorous psychological intervention with

behavioral techniques or psychotherapy with or without

psychotropic drugs, and (2) suggestion therapy using a

variety of techniques.

Reports of adults with habit cough suggested that

intense psychotherapy, counseling, and speech therapy

resulted in a decrease of symptom severity in a small

number of patients who accepted it [17, 18]. The same

authors treated other patients successfully with speech

therapy alone, but gave no follow-up data or details of the

cases involved. ‘‘Response suppression shaping,’’ utilizing

painful electric shocks, was used successfully in two

teenage boys with no relapses after 1.5–2.5 years of follow-

up [36, 37]. Prior to this therapy, one coughed so

severely that he lost consciousness. One of these patients

required more than 100 sessions, whereas the other patient

discontinued his cough immediately after one shock. An

‘‘elevated level of anxiety, neuroticism, affective lability,

hyperactivity, low tolerance to frustration’’ were found in

all ten patients from one report [19], with a good response

to mild tranquilizers and prolonged psychotherapy.

One of the earliest references to successful use of suggestion

therapy for treatment of habit cough came from

Bernstein in 1963 [1]. He described a dramatic and lasting

resolution of a severe habit cough in a 12-year-old girl after

one session of suggestion therapy. Follow-up of over

1 year showed no significant relapses. A few mild, selfcontrolled

episodes of habit cough were noted during the

first 3 days after the suggestion therapy session. Hypnosis

had been used on the same child for habit cough two times

prior to suggestion therapy with no success. In 1966,

Berman [3] reported on six patients with habit cough

successfully treated with therapy that ‘‘relied solely on the

art of suggestion.’’ The children were told that the cough

was a habit, that there was no evidence of disease causing

symptoms, and therefore the cough was unnecessary and

must stop. Within a few days, the habit cough gradually

subsided and did not recur during a 2-year follow-up period.

Special attention was paid in that report to the possibility

of psychological or emotional disturbances as a cause

of cough, but only in one case was there a suggestion to

school phobia.

In a review of functional respiratory disorders, Rabin [4]

stated that ‘‘symptoms could be alleviated by reassurance

from an understanding family physician’’ in most cases, but

he also warned: ‘‘If the symptoms do not respond rather

promptly to reassurance and suggestive measures, expert

psychiatric help should be sought.’’ Rabin’s report, however,

gave no indication of his success rate. Kravitz et al.

[5] and later Weinberg [7] reported treating a total of 12

cases of habit cough using suggestion and reassurance,

with the addition of mild tranquilizers and psychotherapy

in some cases. They felt that school phobia was a factor in

all but one of their patients. Lorin et al. [16] reported a

striking case of an 11-year-old girl with habit cough. The

coughing was so severe that she had sustained rib fractures.

She was diagnosed with an ‘‘adjustment reaction with

obsessive, hysterical, and phobic features.’’ Her parents did

not allow her to have psychotherapy. A single session of

suggestion therapy utilizing a lollipop as a ‘‘distractor’’ was

then tried with prompt cessation of symptoms; she

remained asymptomatic 7 years later.

The largest group of habit cough patients treated with

suggestion therapy had a bed sheet tightly wrapped around

the patient’s chest, with strong verbal reinforcement that this

would stop the cough [15]. Thirty-one of 33 patients treated

in this manner then became cough-free within 24–48 h of

this suggestion therapy. The long-term outcome, ranging

from 10 months to 21 years (median = 14 months),

showed success in 17 of 18 patients with follow-up data.

There has been a subsequent report of success with the same

technique on six patients, with no further symptoms reported

1 week after the treatment [14].

Hypnosis has been used successfully in children by

Anbar [38, 39], using a technique he terms self-hypnosis.

One patient was reported as successfully treated with selfhypnosis

taught by telephone [40]. Biofeedback and cognitive

coping were used for treating one 11-year-old girl

with classical habit cough [41]. She was described as

cough-free after six 1-h sessions. Vocal fold injection with

botulinum toxin was used in three children, ages 11–13,

with transient improvement [42]. Subsequent control was

reported attained with four to eight sessions of behavioral

therapy.

In our own study [9], all nine patients with habit cough

were treated with suggestion therapy without psychotherapy

or psychotropic medications. Eight responded well

with no more than minor self-controlled symptoms reported

during the long-term follow-up (range = 8 days to 9.4 years; median = 2.2 years). One patient required a

second session of suggestion therapy 9 days after the first

session and subsequently remained symptom-free.

Approach to Successful Suggestion Therapy

We regard suggestion therapy as a means to empower the

patient with the ability to resist the urge to cough. Distractors

provide an alternative behavior to the cough. They

should match the physician’s version of the origin of the

habit cough as explained to the patient. The habit cough

and the way the distractor will help should be explained to

the patient clearly and without any ambiguity. The distractor

cannot be regarded as a placebo treatment in itself;

our experience suggests that attempts at therapy where

medication is prescribed to stop the cough result in failure.

Our success with suggestion therapy has been predominantly

with those who were acutely symptomatic at the

time. This treatment has generally consisted of a single

short session of suggestion therapy by a staff physician that

utilizes a distractor, most commonly 0.5 ml of 1% lidocaine

diluted to 3–5 ml with normal saline for most of our

patients. A glass of warm water sipped slowly when the

urge to cough is perceived has also been used as an alternative

behavior with equal success. The cough is explained

to be a response to a perceived irritation in the airway that

results in a vicious cycle of cough in response to irritation

which causes more irritation and thereby more cough. The

patient is instructed to focus on the distractor (slow deep

breaths of the aerosol or sips of the body temperature water

when the urge to cough is perceived) while listening to a

constant patter from the physician telling the patient that

the distractor will help sooth the irritation inducing the

cough and that this would help the patient resist the urge to

cough. Primary emphasis is placed on the fact that it is the

patient who actually is resisting the urge to cough and that

the distractor is only soothing the irritation; this enables the

patient to break the vicious cycle of ‘‘cough–irritation–

cough.’’

The major elements of the suggestion therapy sessions

were as follows:

1. Expressing confidence, communicated verbally and

behaviorally, that the therapist will be able to show the

patient how to stop the cough.

2. Explaining the cough as a vicious cycle of an initial

irritant, now gone, that had set up a pattern of coughing

which caused irritation and further symptoms.

3. Encouraging the suppression of cough in order to

break the cycle. The therapist closely observes for the

initiation of the muscular movement preceding coughing

and immediately exhorts the patient to hold the cough back, emphasizing that each second the cough is

delayed makes further inhibition of cough easier.

Utilizing the distractor as an alternative behavior to

coughing is emphasized.

4. Repeating expressions of confidence that the patient

was developing the ability to resist the urge to cough.

5. When some ability to suppress cough is observed

(usually after about 10 min), asking in a rhetorical

manner if they are beginning to feel that they can resist

the urge to cough, e.g., ‘‘You’re beginning to feel that

you can resist the urge to cough, aren’t you?’’

6. Discontinuing the session when the patient can

repeatedly answer positively to the question, ‘‘Do

you feel that you can now resist the urge to cough on

your own?’’ This question is asked only after the

patient has gone 5 min without coughing.

A cough-free period was reached generally within the first

10 min. The complete session was then over in about

15 min. Patients are advised that now that they have

learned they can suppress the cough, they need to continue

concentrating on suppressing the cough for the remainder

of the day. They are further advised to treat minor

recurrences promptly by isolating themselves, using sips

of tepid (body temperature) water to ‘‘sooth the irritation,’’

and concentrate on suppressing the urge to cough. It has

been common for the patients to readily do this at home

with generally prompt success.

Complications Encountered

While suggestion therapy is usually successful in treating

habit cough, I have had three cases with unusual, undesirable,

and perplexing outcomes.

The first case was an 8-year-old girl with classical habit

cough that stopped with the usual suggestion therapy. She

returned the following week with excessive drinking and

urinating, consistent with polydipsia and polyuria that was

behavioral in nature. Once that was managed by restricting

the intake of water, she developed polyphagia. Psychiatric

consultation was obtained.

The second case was a 10-year-old boy referred from

Northwestern Iowa, 300 miles from us, with an initial

history consistent with classical habit cough syndrome. He

had been seen initially by a local psychiatrist and eventually

institutionalized. The nature of the treatment was

unclear but appeared to have been somewhat verbally

accusatory regarding the nature of the cough. Apparently

the coughing increased in severity to the extent that food

ingestion was limited and considerable weight loss occurred.

Upon arrival at our clinic, he exhibited a somewhat

soft cough rather than the barking cough described at initiation

of the problem several months earlier, but the cough occurred with each exhalation during all waking hours. Our

usual suggestion therapy was ineffective. He was admitted

to our extended care facility for attempted rehabilitation

and only very gradually improved.

The third case was a 14-year-old boy, a very bright

straight A student, who had been diagnosed with depression

the previous year according to the referring pediatrician.

The boy himself stated that his problem had been

chronic fatigue syndrome. His cough, present for about

2 months, was consistent with classical habit cough syndrome.

The referring pediatrician had diagnosed this

patient as having habit cough syndrome and had utilized

local specialists to provide suggestion therapy and hypnosis

without benefit prior to the referral. The boy and his parents

were skeptical about further behavioral attempts at

stopping the coughing which had kept him out of school for

the previous 2 months. There was no history to support

school avoidance. To the contrary, he reported liking

school, had friends, and excelled academically. An attempt

at suggestion therapy by me was unsuccessful. A bronchoscopy

found no airway malacia but a large lingual tonsil

impinging on his epiglottis was suspected to perhaps be a

nidus of irritation acting as a stimulus for the cough. A

lingual tonsil debulking by a pediatric otolaryngologist was

associated with cessation of the cough, but 2 days later he

began having pharyngeal spasms along with a gulping

sound several times per minute during waking hours. This

was associated with decreased oral intake, weight loss, and

continued inability to attend school. A further complaint

was persistent headache. Sleep was impaired but the parents

described cessation of the ‘‘gulping’’ once he was

asleep. An attempt at habit cessations by one of our psychologists

skilled in that technique and at teaching pharyngeal

muscular control by our most experienced speech

pathologist were not successful. He was subsequently

referred to a psychologist closer to home who was experienced

at biofeedback, but he and his parents remained

skeptical of such efforts.

These 3 cases are notable as outliers during 35 years of

seeing at least two cases of habit cough annually cured with

suggestion therapy. They stand as exceptions to the general

experience that habit cough is responsive to suggestion

therapy and is not associated with evidence of underlying

psychopathology or additional somatization.

Discussion

The origin of the habit cough remains unclear. However, it

is associated with considerable morbidity and disruption of

life and can result in considerable iatrogenic problems due

to misdiagnosis. Conflicting views are presented by those

who approach it as a manifestation of severe psychological problems and those who concentrate on the respiratory

symptoms alone. If the rationale for an approach can be

judged by the results of the therapy, then the therapy with

the fastest symptom resolution and the lowest relapse rate

may be accepted as the answer to this clinical problem until

more in-depth prospective studies are available.

The use of hypnosis, psychotropic medications, or psychiatric

hospitalization that did not incorporate some form

of suggestion toward cough suppression have not resulted

in cough cessation. The consequence of simply diagnosing

and counseling the patient can result in a prolonged

symptomatic course for many patients [8]. On the other

hand, suggestion therapy aimed at empowering the patient

with the ability to resist the urge to cough results in rapid

and sustained resolution of symptoms in almost all the

patients for whom it had been used.

Conclusion

From the point of view of therapeutic simplicity and

immediate and long-term success, suggestion therapy

appears to be an effective, rapid, and cost-effective means

of treatment. Making the diagnosis requires that the clinician

be alert to the clinical characteristics of habit cough

syndrome and have an index of suspicion based on the

clinical characteristics. Organic disease needs to be effectively

ruled out. For the majority of patients, a careful

history, a chest roentgenogram, and pulmonary function

tests should be sufficient to assure the physician as well as

the patient’s family that nothing has been missed. Early

recognition of habit cough is essential to prevent overtreatment

and unnecessary morbidity.

Editor note: Please refer to www.HabitCough.com for updated research and outcomes regarding cures via-telemedicine, in-office and by-proxy via watching a YouTube documentary.