Upper airway cough syndrome in 103 children

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Upper airway cough syndrome in 103 children

If your child has coughed for more than four weeks—especially with morning or position-related coughing, a runny nose, or mouth breathing—you’re likely familiar with the frustration of chronic cough. In China, one of the most common causes of this issue is upper airway cough syndrome (UACS), a condition triggered by upper airway problems like rhinitis, sinusitis, or adenoid hypertrophy. A 2019 study by researchers from Beijing’s Children’s Hospital (Capital Institute of Pediatrics) and Peking Union Medical College Hospital shed light on how UACS affects kids of different ages, what causes it, and how to treat it effectively.

What Is Upper Airway Cough Syndrome (UACS)?

UACS isn’t a single disease—it’s a syndrome: a group of symptoms (chiefly chronic cough) caused by issues in the nose, sinuses, or throat. Common triggers include allergic/non-allergic rhinitis (inflammation of the nasal lining), sinusitis (sinus infection), or adenoid hypertrophy (enlarged gland behind the nose that blocks airflow). In China, UACS is the second leading cause of chronic cough in children (24.71%), right after cough-variant asthma.

How the Study Was Done

The research team analyzed 103 children with UACS who visited the Children’s Hospital, Capital Institute of Pediatrics, from January to November 2013. All kids had chronic cough (≥4 weeks) and were referred to the ear, nose, and throat (ENT) department after ruling out lung diseases (via X-ray and lung function tests).

They divided participants into three age groups:

  • Nursing children: 0–3 years (8 kids, 7.8%)
  • Pre-school children: 3–6 years (45 kids, 43.7%)
  • School-age children: ≥6 years (50 kids, 48.5%)

To diagnose UACS, the team used:

  • Clinical exams: Checking for nasal congestion, runny nose, or throat mucus.
  • Nasal endoscopy: To see adenoid size (enlarged if it blocked ≥2/3 of the nasal passage).
  • CT scans: For kids with thick nasal mucus or headaches (to check for sinusitis).
  • Allergen tests: Skin pricks or blood tests for specific IgE (allergic antibodies).

Treatment was standardized for all kids to compare results:

  • Saline nasal rinses
  • Nasal glucocorticoids (to reduce inflammation)
  • Antihistamines or leukotriene inhibitors (for allergies)
  • Mucus thinners
  • Antibiotics (if sinusitis was present)

The team tracked progress using:

  • Visual Analog Scale (VAS): Parents or kids rated cough severity from 0 (no cough) to 10 (worst possible).
  • Objective tests: Nasal endoscopy (1 month post-treatment) or sinus CT (3 months post-treatment).

Key Findings by Age Group

The study’s biggest takeaway? UACS causes and symptoms change with age—a critical detail for diagnosis and treatment.

1. Most Common UACS Triggers

Overall, the top cause of UACS was rhinitis + adenoid hypertrophy (36.9% of kids). But when broken down by age:

  • Nursing children (0–3 years): Rhinitis was the main cause (75% of cases).
  • Pre-school children (3–6 years): Adenoid hypertrophy (enlarged glands) was the leading trigger (22.2% alone; 48.9% with rhinitis).
  • School-age children (≥6 years): Rhinitis (26%) and sinusitis (26%) were most common—adenoid issues dropped significantly.

Why the shift? Younger kids have smaller airways, so enlarged adenoids (mechanical blockage) are more likely to cause cough. As kids grow, they’re exposed to more allergens, germs, and irritants—so inflammatory issues like rhinitis and sinusitis become more prevalent.

2. Secondary Symptoms Vary by Age

Chronic cough was the main complaint, but additional symptoms helped doctors spot UACS:

  • Nursing kids: Mouth breathing (75%) and snoring (12.5%).
  • Pre-school kids: Snoring (51.1%) and mouth breathing (28.9%).
  • School-age kids: Runny nose (26%), headaches (18%), and nasal congestion (12%).

Younger kids can’t always describe how they feel—so parents should watch for physical signs like mouth breathing. Older kids can articulate symptoms like headaches, which point to sinusitis.

Does Allergy Play a Role?

Allergies are a known trigger for UACS, but the study found:

  • 43.7% of kids had positive allergen tests (more boys: 29 vs. 16 girls).
  • Allergy rates didn’t vary by age—meaning allergies are a common factor across all age groups, but not the reason UACS causes change with age.

This suggests anti-allergy treatments (like antihistamines) are helpful for most kids with UACS, regardless of how old they are.

How Effective Is UACS Treatment?

The team wanted to know: How long does treatment need to work? The answer came from VAS scores:

  • 2 weeks post-treatment: Cough severity dropped significantly (all P < 0.01).
  • 12 weeks post-treatment: Scores plateaued—no major improvement after that.

In short: 12 weeks of treatment is enough for most kids. Objective tests (endoscopy, CT) confirmed that nasal/sinus inflammation had improved by 3 months.

Only 8 kids needed adenoid surgery (between 2015–2016) because their enlarged glands didn’t respond to meds.

What Parents Should Know

This study gives clear, actionable advice for families dealing with UACS:

  1. Age matters for diagnosis:

    • If your toddler has a chronic cough + mouth breathing, ask about adenoid hypertrophy.
    • If your school-age child has a cough + runny nose/headaches, check for rhinitis or sinusitis.

  2. Allergies are common: Even if your child doesn’t have “classic” allergy symptoms (like sneezing), get them tested—allergies often drive UACS.

  3. Stick to the 12-week treatment plan: Don’t stop meds early! The study showed coughs keep improving until week 12, then stay better.

  4. Track secondary symptoms: Write down what else your child is experiencing (e.g., snoring, headaches)—it’ll help your doctor narrow down the cause faster.

Conclusion

UACS is a common, treatable cause of chronic cough in kids—but it’s not a “one-size-fits-all” condition. The study by Gao, Gu, and Jiang shows that age dictates both the cause and symptoms of UACS, so treatment should be tailored to your child’s stage of development.

For parents, the takeaway is simple: Pay attention to your child’s unique symptoms, work with an ENT specialist to find the right trigger, and trust the 12-week treatment timeline—most kids will see significant relief.

This study was published in the Chinese Medical Journal in 2019 by Fan Gao (Department of Otorhinolaryngology, Children’s Hospital, Capital Institute of Pediatrics, Beijing), Qing-Long Gu (same institution), and Zi-Dong Jiang (Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing).

doi.org/10.1097/CM9.0000000000000118

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