Upper Airway Cough Syndrome (UACS)

A.K.A. Post-Nasal Drip

Pt >6 y/o with atopy presents with cough x4 weeks. Parents report rhinorrhea, nasal stuffiness, sneezing, itching. No wheezing, suspicion of foreign body aspiration. Afebrile with post-nasal drainage and cobblestoning of posterior pharynx on exam.

• Pt > 2 y/o: Start intranasal fluticasone (Veramyst) 27.5 mcg/spray, one spray per nostril daily

• Loratadine

  • Pt 2-6 y/o: Start loratadine 5mg qd

  • Pt > 6 y/o: Start loratadine 10 mg qd

• Parents advised to make f/u appointment if no clinical improvement within 2 months

Notes

• Chronic cough in children defined as > 4 weeks

• UACS is estimated to be the 3rd most common cause of cough in children younger than 6 years

  • Asthma = 36%

  • Protracted bacterial bronchitis = 12%

  • Upper airway cough syndrome = 9%