Diagnosis and Treatment of “Nervous Cough”

Abstract

Coughing occurs not only due to irritation of the air tract but also by emotional irritation. Symbolic cough reaction and cough symptoms develop when human feelings are stimulated. So-called “nervous cough” is not necessarily a common disorder, but easily takes a chronic course and is difficult to improve unless precise diagnosis and treatment are performed. Nervous cough is characterized by paroxysmal or continuous dry cough induced by some psychogenic mechanism. However, even when psychogenic or neurogenic mechanisms are suspected, episodes of acute upper respiratory infection, pharyngolaryngitis or bronchitis may play an important role in the development of nervous cough. Differential diagnosis with lasting chronic cough is very important, particularly with cough variant asthma. It is assumed that some psychosocial stressor contributes to processing sensitivity to cough reflex and developing of nervous cough. Nervous cough is sometimes expressed as a symbolic symptom (conversion symptom) caused by hysteria, cough as an outlet of internal strain, and similar symptom as myospasia impulsive (vocal tic). Bio-psycho-social understanding and approach are required for diagnosis and treatment of nervous cough. Anxiety disorder and depressive state often accompany the disease, and antianxiety agents and antidepressants are often effective for treatment. Specific psychotherapy may be applicable when symptoms are aggravated by remarkable psychological factors.