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The ABCs of postnasal drip

What is postnasal drip? Is it really a very common cause of common cough?  How is it treated?


Postnasal drip is a condition that involves the numerous mucus glands present in the lining of our nose (nasal cavity) and throat. Throughout the day, these glands produce a limited amount of mucus that moistens and cleans these areas, humidifies inhaled air, traps inhaled foreign matter and clears them, and helps destroy pathogenic microorganisms such as bacteria and viruses before they can get into our body and cause infection. Normally, the mucus mixes with saliva and drips unnoticed down our throat, swallowed unconsciously and continuously throughout the day.

When these glands secrete excessive amount of—or very thick—mucus, however, the secretion accumulates in the back of our nose and when it flows down our throat to be swallowed, it becomes annoying and noticeable, and is referred to as postnasal drip. Postnasal drip irritates and makes us want to constantly clear our throat. Often, it also triggers a cough—that is why the condition is also called upper airway cough syndrome (UACS). In fact, postnasal drip is one of the most common causes of chronic cough. Excess mucus running down our throat may also make us feel hoarse and give us a sore throat.

(Manila Bulletin)

(Manila Bulletin)

 Causes of postnasal drip

Postnasal drip occurs when there is infection of the upper respiratory tract such as cold, flu, rhinitis, and sinusitis or if there is an anatomic defect in the nose such as a deviated nasal septum. It can be the adverse effect of blood pressure medication or other medications.  It can likewise be brought about by inhalation of fumes from chemicals, perfumes, cleaning products, smoke, or other irritants. Sometimes, its underlying cause does not involve the nose at all, as when it is due to gastro esophageal reflux disease (GERD), or by a disorder of swallowing (such as an esophageal motility disorder). But very often, postnasal drip is triggered by an allergy (allergic post nasal drip), which may be seasonal or persistent throughout the year.

Treatment for postnasal drip

The treatment of postnasal drip depends on what causes it. Bacterial infections are treated with antibiotics while colds and other viral infections only need symptomatic management. Anatomic defects of the nose are repaired surgically whereas the GERD is usually treated medically with antacids and/or a variety of drugs that inhibit acid production by the stomach.

The ideal approach to treating allergic postnasal drip is to identify its causative allergen and then avoid it. But this is easier said than done. Thus, the first line of treatment for allergic postnasal drip consists of medications that can control its symptoms. The medicines that are used singly or in combination for postnasal drip are the antihistamines, decongestants, and steroid medications or nasal sprays. Antihistamines and decongestants relieve the symptoms of postnasal drip that are brought about not only by allergies but also by infections.

The older antihistamines such as diphenhydramine and chlorpheniramine are seldom used for postnasal drip because they dry out mucus and thicken it. They are also highly sedating and give rise to drowsiness. The newer antihistamines, including certirizine, lortidine, desloratadine, fexofenadine, and levocetirizine are less likely to cause drowsiness and are the current choices.

Incidentally, another effective treatment strategy that can markedly help ease the symptoms of postnasal drip is to thin mucus. Keeping the mucus thin or watery makes it easier and less bothersome to swallow. The best way to thin mucus is to drink a lot of water.

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