From the Guidelines
Treatment for cough-induced syncope should primarily focus on suppressing the cause of cough, as recommended by the European Heart Journal guidelines 1. The initial approach to managing cough-induced syncope involves education on avoiding triggering events, recognizing premonitory symptoms, and using maneuvers to abort the episode, such as assuming a supine posture.
- Key strategies include:
- Suppressing the cause of cough
- Avoiding triggering events like hot crowded environments, volume depletion, and tight collars
- Recognizing premonitory symptoms
- Using maneuvers to abort the episode, like supine posture According to the guidelines 1, the treatment goals are primarily prevention of symptom recurrence and associated injuries, as well as improved quality of life.
- Practical measures to control cough and prevent syncope include:
- Staying well-hydrated
- Avoiding cough triggers
- Sitting or lying down when feeling a severe cough coming on to prevent falls and injury It is essential to address trigger factors directly, and if possible, strategies should be implemented to prevent the vasovagal response that leads to fainting, as supported by basic physiological knowledge and small studies 1.
From the Research
Treatment for Cough Induced Syncope
- Cough syncope is a form of neurocardiogenic syncope that occurs immediately after coughing due to arterial baroreflex-mediated vasodilatation 2.
- It has been classically described in patients with obstructive pulmonary diseases, and pulmonary vascular diseases can also present with cough syncope 2.
- A novel treatment for malignant cough syncope has been described, which involves managing a case of a young male presenting with recurrent attacks of malignant cough syncope 2.
- Inhaled bronchodilators, such as tiotropium bromide, are the mainstay of pharmacological treatment for stable chronic obstructive pulmonary disease (COPD), which can help alleviate cough induced syncope 3, 4, 5.
- Tiotropium bromide has been shown to improve lung function, dyspnea, and health-related quality of life, and decrease the incidence of acute COPD exacerbations and the use of rescue medication 4, 5.
Management of Cough Syncope
- Early identification, comprehensive diagnostic evaluation, and appropriate driving advice are fundamental to protect patients and the public 6.
- Cough syncope is a rare but serious and potentially life-threatening complication of chronic cough, and its management requires a thorough understanding of the underlying causes 6.
- The treatment of cough syncope should focus on addressing the underlying condition, such as COPD, and managing the symptoms to prevent further episodes of syncope 3, 2, 4, 5.