Upper airway cough syndrome

Chronic cough that occurs with coexisting upper airway symptoms, including abnormal sensations arising from the throat and a postnasal drip sensation.

Sensations attributed to nasal disease may actually be manifestations of a sensory neuropathic process and not related to rate or quantity of nasal discharge.

No pathognomonic findings exist.

Trial of empiric therapy with a first-generation antihistamine plus a decongestant is considered to be both diagnostic and therapeutic.

Nonpharmacologic therapies also form part of the treatment pathway. Coexisting conditions should be evaluated and managed.

Can have a significant impact on quality of life.

The American College of Chest Physicians defines upper airway cough syndrome (UACS) as a syndrome characterized by chronic cough (i.e., present for ≥8 weeks) related to upper airway abnormalities.​​​​[1]Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(suppl 1):63S-71S. https://journal.chestnet.org/article/S0012-3692(15)52833-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/16428694?tool=bestpractice.com

​Central to the diagnosis is the presence of abnormal sensations arising from the throat (e.g., patients may describe something stuck in the throat). One study considered UACS to be a persistent dry cough present for at least 8 weeks' duration associated with the sensation of mucus in the throat.[2]Macedo P, Saleh H, Torrego A, et al. Postnasal drip and chronic cough: an open interventional study. Respir Med. 2009 Nov;103(11):1700-5. http://www.resmedjournal.com/article/S0954-6111(09)00153-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/19481918?tool=bestpractice.com

Some physicians and guidelines have challenged the existence of UACS as a distinct clinical entity.[3]European Respiratory Society. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. 2020 [internet publication]. https://erj.ersjournals.com/content/55/1/1901136 ​​[4]Chung KF, McGarvey L, Song WJ, et al. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers. 2022 Jun 30;8(1):45. https://pmc.ncbi.nlm.nih.gov/articles/PMC9244241 http://www.ncbi.nlm.nih.gov/pubmed/35773287?tool=bestpractice.com [5]Donaldson AM. Upper airway cough syndrome. Otolaryngol Clin North Am. 2023 Feb;56(1):147-55. http://www.ncbi.nlm.nih.gov/pubmed/36283869?tool=bestpractice.com [6]Parker SM, Smith JA, Birring SS, et al. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax. 2023 Dec 6;78(suppl 6):s3-19. https://thorax.bmj.com/content/78/Suppl_6/s3.long http://www.ncbi.nlm.nih.gov/pubmed/38088193?tool=bestpractice.com ​​​​​​ For example, the British Thoracic Society recommends diagnosis of patients with chronic cough as a general term and defining treatable traits (e.g., reflux, use of ACE inhibitors) rather than using terms such as UACS. The diagnostic precision of clinical assessment for this syndrome and the presence of a direct causal relationship between upper airway abnormalities and chronic cough has also been challenged. Expert opinion is moving towards a description of many of the features of UACS as being part of a general cough hypersensitivity syndrome.[7]Morice AH, Millqvist E, Belvisi MG, et al. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J. 2014 Nov;44(5):1132-48. https://erj.ersjournals.com/content/44/5/1132.long http://www.ncbi.nlm.nih.gov/pubmed/25142479?tool=bestpractice.com UACS may also coexist with other airway and respiratory conditions.

UACS was formerly known as postnasal drip syndrome.[1]Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(suppl 1):63S-71S. https://journal.chestnet.org/article/S0012-3692(15)52833-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/16428694?tool=bestpractice.com ​ UACS is preferred because it is unclear whether the mechanisms of cough are due to the drainage of secretions from the nose or paranasal sinuses into the pharynx, or the direct inflammation/irritation of cough receptors in the upper airway.[1]Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(suppl 1):63S-71S. https://journal.chestnet.org/article/S0012-3692(15)52833-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/16428694?tool=bestpractice.com ​​​