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 relate to rate or quantity of nasal discharge.
Most common cause of chronic cough in adults.
No pathognomonic findings exist; diagnosis should be determined by considering a combination of criteria, including the history, physical exam, imaging, and, ultimately, the response to therapy.
Trial of empirical therapy with a first-generation antihistamine plus a decongestant is both diagnostic and therapeutic. Non-pharmacological therapies also form part of the treatment pathway.
Can have a significant impact on quality of life.
The American College of Chest Physicians defines upper airway cough syndrome (UACS) as a syndrome characterised by chronic cough (i.e., present for ≥8 weeks) related to upper airway abnormalities. The presence of abnormal sensations arising from the throat (e.g., patients may describe something stuck in the throat) is central to the diagnosis. One study defines UACS as a persistent dry cough present for at least 8 weeks’ duration associated with the sensation of the presence of mucus in the throat.
It is important to be aware that some physicians with an interest in chronic cough have challenged the existence of UACS as a distinct clinical entity. The diagnostic precision of clinical assessment for this syndrome 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. UACS may also coexist with other airway and respiratory conditions.
UACS was formerly known as postnasal drip syndrome; however, the term UACS is now preferred. This is 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.
History and exam
Key diagnostic factors
- unpleasant sensation in throat
- postnasal drip
- cobblestone mucosa
Other diagnostic factors
- nasal abnormalities
- symptoms of rhinitis
- posterior pharyngeal mucus
- voice disturbance
- seasonal triggers
- occupational triggers
- female gender
1st investigations to order
- empirical treatment trial
- chest x-ray
Investigations to consider
- direct nasolaryngoscopy
- serum IgE level
- specific aeroallergen radioallergosorbent test (RAST)
- peak expiratory flow rate (PEFR)
- CT sinus
suspected upper airway cough syndrome (UACS)
confirmed upper airway cough syndrome (UACS)
- Other causes of chronic cough
- Allergic rhinitis
- Non-allergic rhinitis (perennial)
- Treatment of unexplained chronic cough
- Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome)
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