Sinusitis and Chronic Progressive Exercise-Induced Cough and Dyspnea

Cough plays a significant physiologic role in the respiratory system’s defense system as it protects the lower airways and enhances the clearance of excess secretions from the airways. On the other hand, chronic cough may become a debilitating symptom. Chronic cough is defined as a cough persisting longer than 8 weeks in adults and 4 weeks in children. It is difficult to estimate the exact prevalence of chronic cough. A study of 16 countries worldwide reported that prevalence of nocturnal, productive, and non-productive cough was 30%, 10%, and 10%, respectively. Indeed, it is associated with morbidity such as sleep disturbance, urinary incontinence especially in women, syncope, depression, and impairment of the quality of life (QOL). Often, these morbidities drive the patient to the clinics. Cigarette smoking and use of an angiotensin-converting enzyme (ACE) inhibitor are the two other major reasons. In most of the remaining patients, there are three common etiological factors such as upper airway cough syndrome (UACS), asthma, and reflux. UACS was previously referred to as postnasal drip syndrome (PNDS). Every diagnosis is the realm of different specialists and may be present alone or in combination. Cough may arise from anywhere in innervation area of the vagus and full assessment of the anatomy of vagus nerve is important in differential diagnosis of chronic cough. Therefore, multidisciplinary approach is mandatory. Considering potential origin of chronic cough, determining a diagnosis, and treatment of the cause are the key points of successful management.