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 empiric therapy with a first-generation antihistamine plus a decongestant is both diagnostic and therapeutic. Nonpharmacologic 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 characterized by chronic cough (i.e., present for ≥8 weeks) related to upper airway abnormalities.
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 the presence of mucus in the throat.
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. 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.
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
- empiric treatment trial
- chest x-ray
- erythrocyte sedimentation rate
Investigations 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
suspected upper airway cough syndrome (UACS)
confirmed upper airway cough syndrome (UACS)
- Other causes of chronic cough
- Allergic rhinitis
- Nonallergic rhinitis (perennial)
- ACR appropriateness criteria: chronic cough
- ERS guidelines on the diagnosis and treatment of chronic cough in adults and children
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