Coughs are common, but some persist, becoming a chronic concern. Upper Airway Cough Syndrome (UACS) is a frequent cause of lingering coughs, accounting for a substantial number of chronic cases.
Defining Upper Airway Cough Syndrome
Upper Airway Cough Syndrome (UACS), previously known as postnasal drip syndrome, describes a persistent cough originating from irritation or inflammation within the upper airways. This irritation often stems from mucus or other substances dripping down the back of the throat, known as postnasal drip.
Individuals with UACS typically experience a cough that can feel like a “tickle” or an unpleasant sensation in the throat. The cough may worsen at night or upon waking, often accompanied by a frequent need to clear the throat. Other common associated symptoms include a sensation of something being stuck in the throat, hoarseness, and nasal symptoms like congestion or discharge.
Common Triggers
Upper Airway Cough Syndrome is frequently triggered by underlying conditions that lead to excessive mucus production or irritation in the upper respiratory tract.
Allergic rhinitis, an inflammatory response to allergens, is a common cause of UACS-related cough. Exposure to allergens like pollen, dust mites, or pet dander can cause nasal passages to produce excess mucus, which then drips down the throat.
Non-allergic rhinitis, which involves nasal inflammation not caused by allergens, can also contribute to UACS. This type of rhinitis can be triggered by various factors, including environmental irritants, changes in temperature, or certain medications.
Sinusitis, an inflammation of the sinuses, similarly leads to increased mucus drainage into the throat. Gastroesophageal reflux disease (GERD) can also cause UACS, particularly a form known as laryngopharyngeal reflux (LPR). In LPR, stomach acid travels up to the throat and voice box, irritating these sensitive areas and often triggering a cough without typical heartburn symptoms.
Identifying and Treating the Condition
Diagnosing Upper Airway Cough Syndrome typically begins with a thorough physical examination and a detailed review of a patient’s symptoms and medical history. While there are no specific diagnostic tests exclusively for UACS, healthcare providers often look for signs such as mucus in the back of the throat or a “cobblestone” appearance of the pharynx, which indicates chronic irritation.
Diagnostic tests, like allergy testing, might be performed to identify specific triggers if allergic rhinitis is suspected. In cases where GERD is a potential cause, an endoscopy may be considered to assess irritation in the esophagus and throat.
Treatment for UACS primarily focuses on managing the underlying condition causing the upper airway irritation.
For rhinitis, both allergic and non-allergic types, treatment often involves a combination of medications. Antihistamines, particularly first-generation ones, can help reduce mucus production and alleviate cough, sometimes combined with decongestants. Nasal corticosteroids, such as fluticasone or mometasone, are also highly effective in reducing nasal inflammation and symptoms associated with rhinitis.
For UACS linked to gastroesophageal reflux, management strategies often include lifestyle modifications and medications to reduce stomach acid. Elevating the head during sleep and avoiding trigger foods can help alleviate reflux symptoms. Antacids or proton pump inhibitors (PPIs) may be prescribed to decrease stomach acid production, thereby reducing irritation to the throat.
Nasal saline rinses can also be a helpful adjunctive therapy for various causes of UACS, as they help clear mucus and irritants from the nasal passages.
When to Consult a Doctor
Seeking medical attention for a cough is important, especially if it persists or is accompanied by other concerning symptoms.
Individuals should consult a doctor if a cough lasts longer than three to four weeks, as this duration often indicates a chronic issue like Upper Airway Cough Syndrome. It is also advisable to seek medical advice if the cough is accompanied by new or worsening symptoms.
Such symptoms include fever, shortness of breath, chest pain, or coughing up blood.
Additionally, if over-the-counter remedies do not provide relief, or if the cough significantly interferes with daily activities or sleep, a medical evaluation can help identify the underlying cause and guide appropriate treatment.