Upper airway cough syndrome

Abstract

Prevalence of rhinitis and postnasal drip syndrome in patients attending hospital-based clinics with chronic cough were reported between 6% and 87%. American College of Chest Physicians guidelines recommend the term 'upper airway cough syndrome' (UACS) instead of 'postnasal drip' because symptoms of upper airway and cough overlap in patiets with chronic cough. Presence or absence of postnasal drip does not include or exclude UACS as a cause of cough. Hence, the first step empirical treatment should include UACS therapy in all patients with chronic cough. The initial treatment for chronic cough is combination of a 'first-generation antihistamine and an oral decongestant' or 'intranasal corticosteroids and intranasal antihistaminic agents'. Improvement in cough with this combination serves as a treatment and as a diagnostic test for the presence of UACS. If postnasal drip and cough persist despite treatment in the first month, the patient could be unrecognized rhinosinusitis, or nasal polyposis and should planned nasal endoscopy (rhinoscopy) and sinus BT. If this tests will be normal, UACS is not the cause of the chronic cough.