Tic Cough (Habit Cough)

Casandra Arevalo, MD, and Lee J. Brooks, MD, FAAP

Introduction/Epidemiology/Etiology

Introduction

•Tic cough, also called somatic cough syndrome, is a dry cough without an organic cause. It may be subacute or chronic. It may also be known as honking cough, barking cough, and nervous cough.

•Tic cough is often mistaken for asthma, postnasal drip syndrome, or gastroesophageal reflux disease (GERD).

•It can manifest as a chronic cough that disturbs parents, teachers, or any other caretakers.

•It may lead to social disruption (school absence) and becomes more frequent in the presence of teachers and/or parents. It might decrease in intensity with an enjoyable activity (parties, sports, etc).

•It can manifest subsequent to an organic disease, such as a viral illness. In other patients, it can primarily be associated with a psychological disorder, such as anxiety or depression.

•Tic cough might coexist with other cough causing diseases (asthma, GERD, allergies, sinusitis).

•Cough tics can be viewed as a form of a vocal tic and may not be the sole tic in children with tic disorders. A careful history reveals that many children with cough tics have had other tics previously. For some children with cough tics, this is the first of many tics they will develop through childhood.

Epidemiology

•Onset occurs as early as 2 years of age.

•There is no sex predilection in children.

•More than 90% of cases of habit cough have been reported in patients <18 years of age.

Etiology

•One hypothesis is that an initial illness creates a learned subconscious model for the cough (a habit).

•It can be associated with psychogenic stress or with an initial viral respiratory tract infection illness, with subsequent coughing.

•An initial irritant sets up a pattern of coughing.

•There may be secondary gain, such as absence from school.

•Characteristic features of tic cough include

—Harsh, loud, honking or barking cough

—Disruption of normal activities

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