From the Guidelines
For treating post nasal drip in elderly patients, I recommend starting with intranasal ipratropium bromide, as it has been shown to effectively treat watery rhinorrhea syndrome, which is common in this age group due to cholinergic hyperreactivity 1. This approach is supported by the fact that rhinitis in the elderly may be caused by types of rhinitis common in other age groups, but may also be influenced by age-related physiologic changes such as cholinergic hyperactivity, anatomic changes, and medications taken for other medical conditions 1. Some key points to consider when treating post nasal drip in elderly patients include:
- Nasal steroids, such as fluticasone or mometasone, may be safely used for treatment of allergic rhinitis, as they do not cause any clinical or histologic atrophic changes in the nasal mucosa 1
- Selection of medications for rhinitis treatment should take into account that elderly patients may be more susceptible to adverse effects of some of these medications 1
- Intranasal ipratropium bromide should be used with caution in patients with pre-existing glaucoma or prostatic hypertrophy 1
- Environmental modifications, such as using a humidifier and avoiding known irritants, can also help alleviate symptoms of post nasal drip It is essential to note that elderly patients may have more pronounced clear rhinorrhea from cholinergic hyperactivity associated with the aging process, and medications taken for unrelated medical problems may also cause or contribute to rhinitis in this age group 1.
From the FDA Drug Label
Astelin® Nasal Spray is indicated for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older.
- Treatment option: Azelastine (IN) Nasal Spray is a treatment option for postnasal drip in adults, including the elderly.
- Key points:
- Azelastine (IN) is indicated for the treatment of vasomotor rhinitis symptoms, including postnasal drip.
- The drug label does not specify an upper age limit for the treatment of postnasal drip.
- Studies have shown that azelastine (IN) significantly improves symptoms of postnasal drip in patients with vasomotor rhinitis 2.
From the Research
Treatment Options for Post Nasal Drip in the Elderly
- Azelastine nasal spray has been shown to be effective in improving nasal symptoms associated with rhinitis, including post-nasal drip, with a rapid onset of action and a better safety profile compared to intranasal corticosteroids 3.
- Empiric treatment for postnasal drip symptoms should be guided by associated symptoms that suggest either a sinonasal cause or gastroesophageal reflux, and referral to an otolaryngologist is appropriate if symptoms are persistent, unexplainable, or associated with warning signs of malignancy 4.
- In the elderly, treatment of rhinitis should aim to moisten the nasal mucosa, and medications such as second generation antihistamines, intra-nasal anti-inflammatory agents, leukotriene modifiers, and ipratropium nasal spray are generally well tolerated 5.
- Proton pump inhibitors (PPIs) have been shown to be effective in reducing postnasal drip frequency, hoarseness, and chronic cough in patients with extra-esophageal reflux (EER) 6.
- Special considerations need to be made when treating rhinitis in older adults, including comorbidities, limited income, memory loss, and side effects of medications, which can impact outcomes 7.