Upper airway cough syndrome

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 empirical therapy with a first-generation antihistamine plus a decongestant is both diagnostic and therapeutic. Non-pharmacological 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 characterised by chronic cough (i.e., present for ≥8 weeks) related to upper airway abnormalities.​​​[1]American College of Chest Physicians. Diagnosis and Management of Cough. ​Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Jan 2006 [internet publication]. https://www.chestnet.org/Guidelines/Clinical-Pulmonary

​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.[2]Macedo P, Saleh H, Torrego A, et al. Postnasal drip and chronic cough: an open interventional study. Respir Med. 2009 Nov;103(11):1700-5. http://www.resmedjournal.com/article/S0954-6111(09)00153-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/19481918?tool=bestpractice.com

Some physicians with an interest in chronic cough have challenged the existence of UACS as a distinct clinical entity.[3]Morice AH. Post-nasal drip syndrome - a symptom to be sniffed at? Pulm Pharmacol Ther. 2004;17(6):343-5. http://www.ncbi.nlm.nih.gov/pubmed/15564073?tool=bestpractice.com 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.[4]Morice AH, Millqvist E, Belvisi MG, et al. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J. 2014 Nov;44(5):1132-48. https://erj.ersjournals.com/content/44/5/1132.long http://www.ncbi.nlm.nih.gov/pubmed/25142479?tool=bestpractice.com UACS may also coexist with other airway and respiratory conditions.

UACS was formerly known as postnasal drip syndrome.[1]American College of Chest Physicians. Diagnosis and Management of Cough. ​Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Jan 2006 [internet publication]. https://www.chestnet.org/Guidelines/Clinical-Pulmonary ​ 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.[1]American College of Chest Physicians. Diagnosis and Management of Cough. ​Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Jan 2006 [internet publication]. https://www.chestnet.org/Guidelines/Clinical-Pulmonary ​​