Clinical characteristics in adult patients with somatic cough syndrome

Abstract

Objective: The data in regard of the clinical characteristics and diagnosis of somatic cough syndrome in adults were limited. The aim of this study was to fill that gap. Methods: This was a retrospective analysis of patients with somatic cough syndrome. We described clinical characteristics of adult patients with somatic cough syndrome. Results: Twenty-three somatic cough syndrome patients were identified in 543 adult patients with chronic cough. Psychiatric disorder of these patients was identified as anxiety ( n = 8), obsessive-compulsive ( n = 7), somatoform ( n = 6), depression ( n = 3), and cognitive bias ( n = 1). Twelve patients showed abnormal results of investigations related with common causes of chronic cough, including gastroesophageal reflux, sputum eosinophilia, bronchial hyper-responsiveness, or signs of sinusitis but did not respond to the treatments directed to those conditions. All these patients were ever misdiagnosed as other causes of chronic cough. Compared to 520 non-somatic cough syndrome patients, patients with somatic cough syndrome were younger (32 (29.0–43.0) vs 42.0 (32.0–55.0) years, p = 0.013), longer disease duration (48.0 (19.5–102.0) vs 24.0 (9.0–72.0) months, p = 0.037), more common in dry cough (100% vs 57.6%, p < 0.001), and lower proportion of nocturnal cough (13.0% vs 40.2%, p = 0.009). Common cold (60.9%) was the most common initial trigger of cough and itchy throat (60.9%) was the most common accompanying symptom in patients with somatic cough syndrome. Notably, there were similar distribution in cough triggers and accompanying symptoms between two groups. Conclusion: In spite of much higher proportion of dry cough and smaller proportion of nocturnal cough, adult patients with somatic cough syndrome show similar clinical characteristics with other chronic cough patients, in regard of cough triggers, accompanying symptoms as well as abnormal results of investigations, which should be an important reason for misdiagnosis of somatic cough syndrome. Psychiatric disorder should be addressed in clinical management of chronic cough.

Psychological morbidity and chronic cough: which is predominant? A comparison of clinical characteristics

“…Studies have shown that although 54% of psychogenic cough patients who are awake at night have the most serious cough symptoms, 93% of the coughing disappears completely when sleeping, 24 and somatic cough syndrome patients had a lower proportion of nocturnal cough. 6 Our study also showed that although PCC patients had persistent night cough symptoms, the symptoms were milder than the other two groups, which suggests that cough symptoms in this group may be more psychologically related. In addition, in the SCC group, gastroesophageal reflux-induced chronic cough (GERC) was the most common etiology.…”

“…According to some studies, the median duration of psychogenic cough in children is 3 months, 24 while a retrospective study used the term ‘somatic cough syndrome’ with a median course of 48 months in adults. 6 In this study, the median duration of PCC was 6 months, which was shorter than the SCC group. This may be because PCC patients have a basis of psychological disease before the occurrence of cough, as well as sensitivity to their cough symptoms.…”

“… 3 Many studies have confirmed that if chronic cough patients with co-morbid psychiatric diagnoses are offered psychiatric intervention as soon as possible, good results can be achieved, and unnecessary examinations and treatments can be avoided. 4 – 6 Psychological symptoms may be the result of chronic cough. Studies have also shown that in some patients with chronic cough, the incidence of anxiety and depression is increased, and the psychological symptoms of such patients are often improved after effective treatment targeting the cause of cough.…”

Cervical Manipulation and Koren Specific Technique Emotions Protocol in the Improvement of Intensive Nocturnal Dry Cough: A Case Report

“…Distinguishing between somatic chronic cough and non-somatic chronic cough can be challenging [ 5 ], as patients with chronic cough are more prone to experiencing psychological disorders such as anxiety and depression, which can, in turn, exacerbate the coughing. While it is commonly believed that somatic chronic cough tends to occur more frequently when patients are awake and less frequently during sleep, the presence of accompanying physiological conditions such as gastroesophageal reflux, postnasal drip, bronchitis, etc.…”

“…While it is commonly believed that somatic chronic cough tends to occur more frequently when patients are awake and less frequently during sleep, the presence of accompanying physiological conditions such as gastroesophageal reflux, postnasal drip, bronchitis, etc. can still result in pronounced nocturnal coughing [ 5 ]. The presence or absence of nocturnal cough cannot be used as the sole basis for diagnosis; somatic cough syndrome can only be diagnosed when a patient meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria [ 3 , 5 ].…”