Chronic cough: Seeking the cause and the solution

The major causes of chronic cough include upper airway cough syndrome (UACS, formerly known as postnasal drip syndrome), asthma, nonasthmatic eosinophilic bronchitis, and gastroesophageal reflux disease. In fact, one or more of these is the cause of cough in the vast majority of nonsmokers who are not receiving angiotensin-converting enzyme inhibitors and who have no evidence of active disease on chest radiographs. A high index of suspicion is required, because each of these conditions may present with cough as the sole symptom. Because UACS may be the most common cause, it appears reasonable to try empiric UACS therapy in patients in whom other causes are not evident at initial evaluation. In many cases, the combination of a first-generation antihistamine and a decongestant may be most effective.