Cough, psychogenic

psychogenic cough

Disappearance of the cough at night suggests a conscious component to the coughing. Cough from allergic rhinitis, cystic fibrosis, reactive airway disease, and sinusitis would not disappear during sleep. Accordingly, the child in the vignette most likely is exhibiting psychogenic or habitual cough.

The child has had a cough due to a variety of causes at many different
times of his life. Cough usually is triggered by: 1) postnasal drip in
which either the clear mucus or purulent material irritates the
oropharynx; 2) a compensatory mechanism of the lungs to help expel air
when the patient has obstructive lung disease, such as asthma; and 3)
an irritation, which is common with viral pharyngitis. The child in
the vignette has experienced two of these common causes: postnasal
drip from sinusitis and cough due to asthma.

The current cough differs by being both disturbing and relentless,
factors that are extremely important when elucidating the cause. The
most telling clinical clue is disappearance of the cough at night.
With a postnasal drip, patients initially worsen when they lie down
and also when they wake up. The mucus collecting in the posterior
pharynx when the patient is in the supine position during sleep causes
the cough. The body accommodates to the mucus during sleep, and upon
awakening, it needs to be cleared, causing the cough. Asthma is much
worse at night, and a cough in the middle of the night may be a
clinical clue to reactive airway disease or asthma. A cough that is
caused by a viral infection occurs day and night because the
irritation is always present during the course of the illness.

Although the diagnosis of psychogenic cough may be relatively easy to
make, treatment can be difficult. Many patients respond to counseling
and a clinical maneuver, such as coughing in a mirror or counting the
number of times they cough, which helps them to realize the extent of
their coughing. Other times, more aggressive therapy and counseling
are needed.

References:

Prendiville JS, Krol AL. Diseases of the dermis and subcutaneous
tissues. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 3rd
ed. St. Louis, Mo: Mosby, Inc; 2003:713-768

Weston WL, Lane AT, Morelli JG. Skin cysts and nodules. In: Color
Textbook of Pediatric Dermatology. 3rd ed. St. Louis, Mo: Mosby, Inc;
2002:175-176