What is the treatment for postnasal drip?

From the Guidelines

The most effective treatment for postnasal drip is the use of nasal corticosteroids, such as fluticasone or mometasone, which have been shown to reduce total symptom score in adults suffering from acute post-viral rhinosinusitis, although the effect is small 1. When considering treatment options, it's essential to prioritize those that improve morbidity, mortality, and quality of life.

• Nasal corticosteroids are effective in reducing symptoms, but their effect on quality of life is not significant 1.
• Antibiotics have no benefit in treating post-viral rhinosinusitis and can cause adverse events, so they should be avoided 1.
• Systemic corticosteroids do not have a positive effect on recovery and can cause harm, so their use is not recommended 1.
• Decongestants may be effective in improving mucociliary clearance, but there is limited evidence to support their use 1.
• Nasal irrigation with saline may be beneficial, but the evidence is of very low quality, and no strong advice can be given 1.
• Herbal medicines like BNO1016 tablets, Pelargonium sidoides drops, and Myrtol capsules have shown significant impact on symptoms of acute postviral rhinosinusitis without significant adverse events 1. In addition to these treatments, staying hydrated, using a humidifier, elevating your head while sleeping, and avoiding triggers like smoke or strong fragrances can also help alleviate postnasal drip symptoms 1. If symptoms persist beyond 10 days or are accompanied by fever or colored discharge, it's crucial to consult a healthcare provider to determine the best course of treatment, which may include antibiotics for bacterial infections or prescription-strength medications for chronic conditions 1.

From the FDA Drug Label

The studies demonstrated significantly greater reduction in TNSS (sum of nasal congestion, rhinorrhea, sneezing, and nasal itching) with Fluticasone Propionate Nasal Spray, USP, 200 mcg compared to placebo. Three randomized, double-blind, parallel- group, vehicle placebo-controlled trials were conducted in 1,191 patients to investigate regular use of Fluticasone Propionate Nasal Spray, USP, in patients with perennial nonallergic rhinitis These 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 treatment for postnasal drip is Fluticasone Propionate Nasal Spray, USP, which can be administered at a dosage of 100 mcg twice daily. This dosage has been shown to exhibit statistically significant decreases in TNSS, including postnasal drip, compared to vehicle placebo-treated patients 2.

• Adult patients may be started on a 200-mcg once-daily regimen (two 50-mcg sprays in each nostril once daily) or an alternative 200-mcg/day dosage regimen can be given as 100 mcg twice daily (one 50-mcg spray in each nostril twice daily).
• Pediatric patients (4 years of age and older) should be started with 100 mcg (1 spray in each nostril once daily). Treatment with 200 mcg (2 sprays in each nostril once daily or 1 spray in each nostril twice daily) should be reserved for pediatric patients not adequately responding to 100 mcg daily.

From the Research

Treatment Options for Postnasal Drip

• Medical treatment is generally the first line of approach for postnasal drip, as stated in the study 3.
• Intranasal corticosteroids (INS) have been proven effective in controlling postnasal drip, decreasing inflammatory response, reducing nasal swelling, and increasing aeration of the sinuses, as shown in the study 4.
• Antibiotics such as co-amoxiclav may also be used to treat postnasal drip, especially in cases of acute rhinosinusitis, with or without allergic rhinitis, as demonstrated in the study 4.
• Oral gargling with normal saline for 12 weeks has been found to be a safe and potentially effective treatment for postnasal drip syndrome (PNDS), as reported in the study 5.

Evaluation and Management

• The evaluation and management of postnasal drip should be guided by associated symptoms that suggest either a sinonasal cause or gastroesophageal reflux, as suggested in the study 6.
• Investigations are aimed at trying to clearly define the cause of the increased mucus and then specific treatment can be given to remedy the situation, as stated in the study 3.
• Referral to an otolaryngologist is appropriate if symptoms are persistent, unexplainable, or associated with warning signs of malignancy, as recommended in the study 6.

Pathophysiology and New Therapies

• The traditional pathophysiology of postnasal drip related to sinonasal disease does not clearly lead to chronic cough, and the cough from postnasal drip may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions, as discussed in the study 7.
• New therapies and hypothesis regarding the pathophysiology of postnasal drip are being explored, including the concept of upper airway cough syndrome (UACS), as mentioned in the study 5.