From the Guidelines
Yes, Upper Airway Cough Syndrome (UACS) often presents with cobblestone mucosa, which is a characteristic physical finding in the posterior pharynx, as noted in the ACCP evidence-based clinical practice guidelines 1. This cobblestone appearance results from lymphoid hyperplasia and mucosal inflammation due to chronic postnasal drip irritating the pharyngeal tissues. UACS, previously known as postnasal drip syndrome, is one of the most common causes of chronic cough, accounting for approximately 25-40% of cases. When examining patients with suspected UACS, clinicians should look for this cobblestone pattern along with other signs such as:
- Mucus in the posterior pharynx
- Throat clearing
- Nasal congestion The underlying causes of UACS include:
- Allergic rhinitis
- Nonallergic rhinitis
- Rhinosinusitis
- Vasomotor rhinitis Treatment typically involves addressing the underlying cause with:
- Antihistamines
- Decongestants
- Nasal corticosteroids
- Saline irrigation First-generation antihistamines with decongestants (like chlorpheniramine with pseudoephedrine) are often effective due to their anticholinergic properties that reduce secretions, though they may cause sedation, as recommended in the guidelines 1. Intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) or mometasone are particularly helpful for allergic causes and should be used consistently for at least 2-4 weeks to achieve maximum benefit. It is essential to diagnose UACS-induced cough by considering a combination of criteria, including symptoms, physical examination findings, radiographic findings, and, ultimately, the response to specific therapy, as outlined in the guidelines 1.
From the Research
Presentation of Upper Airway Cough Syndrome (UACS)
- UACS is a clinical diagnosis of exclusion with no diagnostic testing or objective findings 2
- The syndrome can be present with or without associated rhinitis and chronic rhinosinusitis 2
Characteristics of UACS
- UACS is one of the most common causes of chronic cough, along with asthma and gastroesophageal reflux 2, 3
- The pathogenesis of UACS remains unclear, with various proposed theories including postnasal drip, chronic airway inflammation, and sensory neural hypersensitivity 3
- UACS can be associated with allergic rhinitis, non-allergic rhinitis, and chronic rhinosinusitis 4
Physical Signs of UACS
- A cobblestone appearance of the oropharyngeal mucosa or mucus in the oropharynx can be present in patients with UACS 5
- Other physical signs may include septum deviation, turbinates hypertrophy, and mucosal thickening 4
Diagnosis and Treatment of UACS
- Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific 6
- Treatment may include dual therapy with H1 receptor antihistamines and decongestants 2, as well as nasal saline solution irrigation 6
- Chinese medicinal herbs may be a safe and effective alternative for the treatment of UACS 5