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When a patient presents with a chronic cough lasting eight weeks or longer and has a normal chest X-ray, it typically narrows down the focus to a few common etiologies often termed the "big three": gastroesophageal reflux disease (GERD), cough-variant asthma (CVA), and upper airway cough syndrome (UACS). Each of these conditions can contribute significantly to the symptomatology of chronic cough, and relevant clinical guidelines provide structured approaches for diagnosis and management in primary care settings.
| Upper Airway Cough Syndrome (UACS) | Mechanism: ↑ Mucus production from nasal/sinus conditions drips into the pharynx, triggering cough. | Clinical Clues: Frequent throat clearing, nasal congestion/discharge, postnasal drip sensation, cobblestoning in oropharynx. | Evaluation/Management: Trial of first-generation antihistamines or nasal corticosteroids; improvement suggests UACS. |
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| Asthma (Cough-Variant) | Mechanism: ↑ Airway hyperresponsiveness and inflammation; in some patients, persistent cough is the main symptom. | Clinical Clues: Wheezing (even if intermittent), chest tightness, cough often worse at night or early morning, triggered by exercise or irritants. | Evaluation/Management: Spirometry with bronchodilator challenge; trial of inhaled bronchodilators or corticosteroids if needed. |
| Gastroesophageal Reflux Disease (GERD) | Mechanism: ↑ Acid reflux into the esophagus and/or microaspiration irritates cough receptors. | Clinical Clues: Heartburn, regurgitation, cough worse when lying flat or after meals, chronic throat irritation.... |
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