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Upper airway cough syndrome

Last reviewed: 28 Oct 2023
Last updated: 08 Aug 2023



History and exam

Key diagnostic factors

  • cough
  • unpleasant sensation in throat
  • postnasal drip
  • cobblestone mucosa
More key diagnostic factors

Other diagnostic factors

  • nasal abnormalities
  • symptoms of rhinitis
  • posterior pharyngeal mucus
  • wheeze
  • voice disturbance
  • heartburn/indigestion
Other diagnostic factors

Risk factors

  • seasonal triggers
  • occupational triggers
  • female gender
More risk factors

Diagnostic investigations

1st investigations to order

  • empiric treatment trial
  • chest x-ray
  • CBC
  • erythrocyte sedimentation rate
  • CRP
  • spirometry
More 1st investigations to order

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
More investigations to consider

Emerging tests

  • bronchoprovocation

Treatment algorithm


suspected upper airway cough syndrome (UACS)


confirmed upper airway cough syndrome (UACS)



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




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.


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


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


Pulmonary, Allergy and Critical Care Medicine

University of Massachusetts Medical School




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




OSU declares that he has no competing interests.

  • Upper airway cough syndrome images
  • Differentials

    • Other causes of chronic cough
    • Allergic rhinitis
    • Nonallergic rhinitis (perennial)
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: chronic cough
    • ERS guidelines on the diagnosis and treatment of chronic cough in adults and children
    More Guidelines
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