LAUSR

DoctorsWright andBalfour-Lynn from theRoyal BromptonHospital in London described the diagnostic characteristics of the Habit Cough in 55 children seen over a 6-year period. The ages of the 55 children (median ∼10 years) were virtually identical to that of the 140 children in whom we made that diagnosis over a 20-year period at the University of Iowa. The prior duration of the cough was also similar, median 3 months seen at Brompton Hospital and 4 months at our clinic. Like our experience in Iowa, the doctors at the Brompton found that a frequent repetitive cough totally absent once asleep was a generally sufficient characteristic to warrant the diagnosis. However, the similarity ended after the diagnosis was made. While many of the Brompton patients continued to cough, some for weeks ormonths, the patients in Iowa left the clinic without the cough The Brompton physicians limited treatment to explanation and reassurance. Similar to a report of children with this problem from Mayo Clinic, (Rochester Minnesota) more than 25 years ago, many had persistent symptoms of this debilitating disorder for weeks or longer. It was over 50 years ago that Dr. Bernard Berman, a Boston allergist, termed the disorder as Habit Cough, and described an effective treatment for this disorder in six children, using measures that he described as relying “solely on the art of suggestion.” Stimulated by Dr. Berman's experience, we began to use a suggestion therapy method in our clinic at the University of Iowa. Our approach emphasized empowering the child with the ability to resist the urge to cough and thereby interrupt what appeared be a vicious cycle where the cough produced a focus of irritation in the airway that acted as the nidus for the continued cough. Our initial report in 1991 described 9 children, median age 11 years, whose repetitive sustained cough present for up to 2 years (median 2months) was stopped using a form of suggestion therapy during the clinic visit. Cessation of the cough occurred within 15min of the suggestion therapy session (30min for 1 very skeptical very bright male adolescent). A 1 week follow-up found one child with no recurrences and eight with minor transient return of symptoms self-controlled with utilization of the autosuggestion technique taught during the clinic visit (Table 1). Seven of the nine could be contacted a median of 2.2 years later. Sustained absence of cough was reported for those seven. A psychological questionnaire, the SCL-90-R, completed by the families of those seven, identified no abnormalities. Following our initial report, we continued that diagnostic and treatment approach. Diagnosis in the Pediatric Allergy and Pulmonary Clinic at the University of Iowa was based on the same criteria described in the Brompton report, a frequent repetitive cough totally absent once asleep. Eighty-five patients seen over a 20-year period had the typical cough present when seen in our clinic. Those patients were treated with suggestion therapy by one of six pediatric pulmonologists. Cessation of coughwas accomplishedwith suggestion therapy by the attending clinician in all but three patients. Details of the treatment failures are described in a subsequent review of the subject. Fifty-five patients seen during the 20-year period had a convincing history of active habit cough but were not coughing during the clinic visit. Where cough was not present when seen in the clinic, autosuggestion, the same principle as our suggestion therapy was taught so that the child could prevent any return of cough from again becoming chronic (Table 1). Patients were instructed to contact us for return of cough that could not be managed with the autosuggestion techniques. That occurred only once, where the pulmonologist seeing the patient misdiagnosed a 9-year-old girl with nocturnal coughing as habit cough. Another method for treating habit cough was known as the bedsheet technique. This involved wrapping a bedsheet tightly around the child's chest with the strong suggestion that his would enable cessation of coughing. We utilized that once when a young immature child was unable to focus during a suggestion therapy session. Hypnosis, which can be considered as a type of suggest therapy, has also been described as effective for this disorder. With various methods of suggestion therapy that can be utilized by the