Summary
Definition
History and exam
Key diagnostic factors
- cough
- unpleasant sensation in throat
- postnasal drip
- cobblestone mucosa
Other diagnostic factors
- nasal abnormalities
- symptoms of rhinitis
- posterior pharyngeal mucus
- wheeze
- voice disturbance
- heartburn/indigestion
Risk factors
- seasonal triggers
- occupational triggers
- female gender
Diagnostic tests
1st tests to order
- empiric treatment trial
- chest x-ray
- CBC
- erythrocyte sedimentation rate
- CRP
- spirometry
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
Emerging tests
- bronchoprovocation
Treatment algorithm
suspected upper airway cough syndrome (UACS)
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.
Differentials
- Other causes of chronic cough
- Allergic rhinitis
- Nonallergic rhinitis (perennial)
More DifferentialsGuidelines
- ACR appropriateness criteria: chronic cough
- ERS guidelines on the diagnosis and treatment of chronic cough in adults and children
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