Last reviewed: September 2018
Last updated: September  2018

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 investigations

1st investigations to order

  • empiric treatment trial
  • CXR
  • CBC
  • ESR
  • CRP
  • spirometry
Full details

Investigations to consider

  • direct nasolaryngoscopy
  • serum IgE level
  • specific aeroallergen radioallergosorbent test (RAST)
  • peak expiratory flow rate (PEFR)
  • CT sinus
Full details

Emerging tests

  • bronchoprovocation
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

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.

Consultant Respiratory Physician

Respiratory Medicine

Royal Brompton Hospital

London

UK

Disclosures

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

Peer reviewers VIEW ALL

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.

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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