What are the symptoms and management of postnasal drip (PND)?

From the Guidelines

Post-nasal drip can be effectively managed with nasal corticosteroids, such as fluticasone, which has been shown to significantly reduce major symptom scores, including congestion and postnasal drip, as demonstrated in the study by Keith (2012) 1. The main symptoms of post-nasal drip include:

• A persistent cough
• Sore throat
• The feeling of mucus dripping down the back of the throat To manage post-nasal drip:

1. Stay hydrated by drinking plenty of water to thin mucus.
2. Use a saline nasal spray 2-3 times daily to flush out irritants and thin mucus.
3. Try over-the-counter antihistamines like loratadine (10mg daily) or fexofenadine (180mg daily) if allergies are suspected.
4. Use a decongestant like pseudoephedrine (30-60mg every 4-6 hours) for short-term relief, but no longer than 3 days.
5. Consider a nasal corticosteroid spray like fluticasone (1-2 sprays per nostril daily) for ongoing symptoms, as it has been shown to be effective in reducing symptoms of postnasal drip, as demonstrated in the study by Meltzer (2012) 1.
6. Elevate your head while sleeping to prevent mucus accumulation.
7. Avoid irritants like smoke and strong odors. Additionally, ipratropium has been shown to reduce rhinorrhea and post-nasal drip, as noted in the review by the Agency for Healthcare Research and Quality (2002) 1. If symptoms persist beyond 10 days or worsen, consult a healthcare provider. They may prescribe stronger medications or investigate underlying causes such as sinusitis or allergies. These treatments work by reducing inflammation in the nasal passages, thinning mucus, and addressing potential allergic reactions, which are common causes of post-nasal drip. The combination of symptom relief and addressing root causes can provide effective management for most cases.

From the FDA Drug Label

The trials evaluated the patient-rated TNSS (nasal obstruction, postnasal drip, rhinorrhea) in patients treated for 28 days of doubleblind therapy and in 1 of the 3 trials for 6 months of open-label treatment Two of these trials demonstrated that patients treated with Fluticasone Propionate Nasal Spray, USP, at a dosage of 100 mcg twice daily exhibited statistically significant decreases in TNSS compared with patients treated with vehicle.

The symptoms of postnasal drip (PND) include nasal obstruction and rhinorrhea. Management of PND may involve treatment with Fluticasone Propionate Nasal Spray, USP, at a dosage of 100 mcg twice daily, which has been shown to exhibit statistically significant decreases in TNSS compared with vehicle. 2

From the Research

Symptoms of Postnasal Drip (PND)

• Postnasal drip is a symptom that can be very irritating to both patient and doctor 3
• PND may be caused by a variety of conditions involving the nose and throat, and often the symptom is not caused by actual secretions draining from the nose into the pharynx 4
• PND can be a symptom of chronic sinusitis and other nasal lesions, and can also be caused by allergic rhinitis, adenoid vegetation, and chronic nasopharyngitis 5, 6
• Postnasal drip symptoms can affect cough control in patients with cough-variant and cough-predominant asthma, and can lead to a longer time until cough disappearance 7

Management of Postnasal Drip (PND)

• Treatment of PND is generally medical, but surgical treatment is required in certain situations 3
• Medical therapy, mainly long-term treatment with low doses of macrolides, can be effective in alleviating symptoms regardless of the cause 5
• Empiric treatment for PND symptoms should be guided by associated symptoms that suggest either a sinonasal cause or gastroesophageal reflux 4
• Treatment of PND should be based on the underlying cause, and can include flushing the nasal cavity by herbal liquid, using glucocorticoid locally, taking medicine of improving the sticky film cilium function, immunotherapeutic or operation 6