Chronic cough and sinonasal disease

O'Hara, J; Carrie, S

doi:10.1183/2312508X.10028224

Chronic cough and sinonasal disease

Lookup NU author(s): James O'Hara ORCiD, Sean Carrie

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Abstract

© ERS 2025. CC often coexists with sinonasal disease, though their relationship remains poorly defined. Upper airway symptoms, such as “post-nasal drip,” are frequently reported but lack clear diagnostic criteria and mechanistic explanation. Chronic rhinosinusitis (CRS), diagnosed by persistent nasal obstruction or discharge for ⩾12 weeks, may contribute to CC through cough reflex hypersensitivity. Management should follow a “treatable traits” approach: treat CRS when symptoms are present using intranasal steroids and saline irrigation for at least 6 weeks; antibiotics and empirical therapies for post-nasal drip syndrome are discouraged. Evidence linking CRS and CC is limited, and only a minority of patients with purulent nasal secretions exhibit cough without other comorbidities. Persistent throat symptoms, often attributed to reflux, show no benefit from PPIs in recent trials, suggesting alternative causes, such as pharyngeal hypersensitivity. Clinical assessment should include nasal examination and, when indicated, endoscopy. Overall, targeted treatment based on symptoms is recommended over empirical strategies.