Chronic cough related to the upper airway cough syndrome: one entity but not always the same

Abstract

Purpose Upper airway cough syndrome (UACS), described as chronic cough (CC) associated with allergic (AR), non-allergic rhinitis (NAR) or chronic rhinosinusitis (CRS), is one of the major causes of CC. We aimed to characterize a cohort of UACS patients with special attention to differences between patients with AR and NAR. Methods A prospective analysis of clinical data of patients, diagnosed with UACS between 2015 and 2018. Results There were 143 patients diagnosed with UACS, median age 52 years, women predominance (68.5%), The group comprised of 59 (41%) AR and 84 (59%) NAR subjects, CRS diagnosed in 17 (12%). Median cough duration: 48 months (IQR 24–120), median cough severity (VAS)—60 mm (IQR 42–78), median Leicester Cough Questionnaire (LCQ) score—11.3 (IQR 8.7–13.7), never-smokers: 70%. The most common symptoms: PND (62%), rhinorrhea (59%), nasal congestion (54%), abnormalities of sinus CT: septum deviation (62%), turbinates hypertrophy (53%), mucosal thickening (53%). UACS as the only cause of CC, was presented in 20 patients (14%). We found no differences between patients with AR and NAR in terms of age, gender, duration and severity of cough, BMI, blood eosinophil count, total IgE and FeNO. AR was associated with higher comorbidity of asthma than NAR (54% vs 35%, p = 0.019). Abnormalities in sinus CT scan were more frequently found in patients with NAR than AR (p = 0.018). Conclusion NAR is the most common upper airway disease associated with UACS. Clinical characteristics of UACS patients with AR and NAR are similar with only minor differences between these groups. It seems reasonable to plan further studies concerning relationship of NAR and cough sensitivity, also in terms of potential similar neurogenic mechanism.

Sinonasal Symptoms in COPD: Burden and Associations with Clinical Markers of Disease

“…added risk of instigating acute exacerbations. [37][38][39] Conversely, population-based longitudinal studies over 5 years have suggested that COPD is a risk factor for developing nasal symptoms 14 and chronic RSsNP. 40 Furthermore, an increase in the prevalence of nasal symptoms over the course of 8 years has been reported in a cohort study.…”

Chronic rhinosinusitis possibly associated with decreased lung function in chronic cough patients

“…A recent study reported that most CC patients had abnormal findings on radiological chest examination, but CRS might be considered as one cause of CC. 5 , 7 In addition, low-dose, long-term macrolide antibiotics treatment could improve lung function in CRS patients with CC who had normal chest X-Ray findings. 6 In this study, the physical examination, chest X-Ray, and pulmonary function test on all patients were done by respiratory physicians, and the patients with subjective symptom of asthmatic cough, wheeze and any abnormal findings of bronchodilator reversibility test were excluded from the study.…”

“… 4 Cough is one of the important symptoms of CRS, and a possible relationship between CRS and CC has been reported. 5 , 6 CRS might also have some impact on the pathogenesis of lung diseases related to CC; 7 however, a definitive mechanism has not been revealed.…”

The Role of Respiratory Flora in the Pathogenesis of Chronic Respiratory Diseases

“…Another study showed significant elevation of both TGF- β 1 and β 2 in mammary secretions of dairy cows infected with Pseudomonas aeruginosa compared to those uninfected, demonstrating the correlation between Pseudomonas aeruginosa and TGF- β 1 and β 2. Meanwhile, Pseudomonas aeruginosa could also stimulate airway inflammation through a variety of known inflammatory pathways, leading to an increase in the prevalence of UACS [ 48 ].…”