Post nasal drip (PND)

POSTNASAL DRIP (upper airway cough syndrome)

Postnasal drip (PND) is the drainage of secretions from the nose or paranasal sinuses into the pharynx. (1)

• often the condition is described as a chronic condition associated with repeated episodes of cold and flu
• there is accumulation of mucus in the postnasal space due to an abnormality in the mucociliary clearance (patient refers to this as catarrh)

It is recognized as one of the “pathogenic triad of chronic cough” (along with asthma and gastroesophageal reflux disease).

American College of Chest Physicians (ACCP) guidelines recommends the term “upper airway cough syndrome (UACS)” instead of PNDS induced cough. UACS is preferred because it is unclear whether the mechanisms of cough are due to the drainage of secretions from the nose or paranasal sinuses into the pharynx, or the direct inflammation/irritation of cough receptors in the upper airway.

In UK both chest physician and otolaryngologists recommend the term ‘rhinosinusitis’ for PNDS. The British Thoracic Society recommends diagnosing patients with chronic cough using a general approach focused on defining treatable traits of cough, rather than using terms like UACS. (2)

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.