Management

Management

The main step in management is to determine the cause of post nasal drip and then to initiate treatment that is directed at this underlying condition (1,2).

In patients without an obvious cause, empiric therapy for PNDS should be started.

Treatment options include;

• avoidance of the offending antigens
• washing with mild alkaline solutions containing borate such as Dobell’s solution (1)
• non-sedative antihistamine e.g. loratadine
• oral decongestant agents - can only be used short-term because of risk of rhinitis medicamentosa
• nasal corticosteroids
• antibiotics if indicated

If a pathological process is not recognized, the patient may have to be counselled with regard to accepting the problem. (3) There is some evidence for the use of non-pharmacological interventions such as speech and language therapy in the management of chronic cough with upper airway features. (4)

Reference:

1. Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(suppl 1):63S-71S.
2. Parker SM, Smith JA, Birring SS, et al. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax. 2023 Dec 6;78(suppl 6):s3-19.
3. Chung KF, McGarvey L, Song WJ, et al. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers. 2022 Jun 30;8(1):45.
4. European Respiratory Society. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. 2020 [internet publication].