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Upper airway cough syndrome

Last reviewed: 13 Oct 2024
Last updated: 05 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • unpleasant sensation in throat
  • postnasal drip
  • cobblestone mucosa
Full details

Other diagnostic factors

  • nasal abnormalities
  • symptoms of rhinitis
  • posterior pharyngeal mucus
  • wheeze
  • voice disturbance
  • heartburn/indigestion
Full details

Risk factors

  • seasonal triggers
  • occupational triggers
  • female gender
Full details

Diagnostic tests

1st tests to order

  • empiric treatment trial
  • chest x-ray
  • CBC
  • erythrocyte sedimentation rate
  • CRP
  • spirometry
Full details

Tests to consider

  • direct nasolaryngoscopy
  • serum IgE level
  • specific aeroallergen radioallergosorbent test (RAST)
  • peak expiratory flow rate (PEFR)
  • CT sinus
  • CT chest with or without intravenous contrast
Full details

Emerging tests

  • bronchoprovocation

Treatment algorithm

INITIAL

suspected upper airway cough syndrome (UACS)

ACUTE

confirmed upper airway cough syndrome (UACS)

Contributors

Authors

Kian Fan Chung, MD, FRCP

Professor of Respiratory Medicine

Head of Experimental Studies Medicine

National Heart and Lung Institute

Imperial College London

Royal Brompton Hospital

London

UK

Disclosures

KFC has received remuneration for taking part in advisory board meetings on asthma, COPD, and cough, organised by GSK, AstraZeneca, Novartis, Merck, Boehringer Ingelheim, TEVA, Menlo Therapeutics, and 4D pharma. KFC has also been on a speaker's bureau for AstraZeneca and Novartis, and has received educational grants from AstraZeneca, GSK, Bionorica, PGT Healthcare, and Vernalis Therapeutics, for supporting the Ninth London International Cough Symposium held in London in 2016.

Acknowledgements

Professor Kian Fan Chung would like to gratefully acknowledge Dr James H. Hull, a previous contributor to this topic.

Disclosures

JHH has received advisory board fees from Menlo Pharmaceuticals, and speaking and travel fees from TEVA and Boehringer Ingelheim.

Peer reviewers

J. Mark Madison, MD

Professor of Medicine

Chief

Pulmonary, Allergy and Critical Care Medicine

University of Massachusetts Medical School

Worcester

MA

Disclosures

JMM declares that he has no competing interests.

Omar S. Usmani, MBBS, PhD, FHEA, FRCP

NIHR Career Development Fellow

Clinical Senior Lecturer

Imperial College London

Consultant Physician in Respiratory & Internal Medicine

Royal Brompton Hospital

London

UK

Disclosures

OSU declares that he has no competing interests.

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