Postnasal Drip in the Bronchiectasis Patient

Posted on March 15, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

According to a recent study, people who have asthma and bronchiectasis are more likely to have persistent swelling of the nasal passages (51%) than people without bronchiectasis (36%).1 This swelling often leads to postnasal drip and coughing that will not go away. Discovering whether a person with bronchiectasis has sinus swelling and/or postnasal drip, will help to improve care.1

Mucus is important to health. Glands in the nose and throat produce about 1-2 quarts of it throughout the day. Mucus moistens and cleans the nasal lining, adds moisture to the air, filters the air, and helps to fight infection. When too much mucus is produced, it can gather in the throat or drip from the back of the nose. This is called postnasal drip.2

Too much mucus may make your voice hoarse. It can also give you a sore, irritated, scratchy throat.In addition, postnasal drip can make you feel like you need to constantly clear your throat. It also can trigger a cough that will not go away and can be worse at night.3

What Causes Postnasal Drip?

Excess mucus that triggers postnasal drip has many possible causes, including:

  • Colds, flu, allergies, and sinus infections
  • Certain medications (including some for blood pressure)
  • Changing weather, cold temperatures, or very dry air
  • Certain foods (e.g., spicy foods may trigger mucus flow)
  • Fumes from chemicals, perfumes, cleaning products, smoke, or other irritants
  • A deviated septum (the crooked placement of the wall that separates the two nostrils) or some other problem with the structure of the nose that affects the sinuses

Sometimes postnasal drip may not be related to producing too much mucus. It may happen if the mucus is not cleared properly. Swallowing problems can cause a buildup of liquids in the throat, which can feel like a postnasal drip. These problems can occur with age, a blockage, or reflux (also known as GERD).

Treatment Options

Treatment of postnasal drip depends on what is causing it. Antibiotics may be used if your doctor thinks that there is an infection.

Antihistamines and decongestants can often help with postnasal drip caused by sinus and viral infections. They can also work with steroid nasal sprays for postnasal drip caused by allergies. It is a good idea to check with your doctor before taking any over-the-counter antihistamines. Many of them can have side effects that range from dizziness, drowsiness, to dry mouth.4

In addition to antihistamines, other treatment options may include an oral decongestant or guaifenesin (a medication that can thin the mucus to help prevent blockages in the ears and sinuses).

Avoid nasal decongestants that constrict blood vessels in the nasal passages unless used under the direction of your doctor.

Be aware that many of these medications are a combination of over-the-counter products. It is important to read the label and avoid taking too much of any active ingredient.

What about prescription treatments?

If the above approaches are not effective, prescription treatments may be the next best steps, including nasal steroid sprays and nasal sprays that inhibit secretions such as mucus.5

Other methods for clearing mucus from your nose include:

  • Use of saline nasal sprays or irrigation (like a neti pot) to flush mucus, bacteria, allergens, and other irritating things out of the sinuses. Sinus washes can help to prevent bacteria from sticking to the nasal passages, reduce swelling inside the nose, and lessen bacteria.
  • Drinking more water. Since thick mucus is stickier and more likely to bother you, staying hydrated can help to thin it out.
  • Increasing the moisture in the air. Leave the window open a crack if possible or leave a clean pot of water under your bed nightly.
  • You can also try propping up your pillows or the head of the bed at 30 degrees at night so that the mucus doesn't pool or collect in the back of your throat.

If you have allergies, here are some other ways to reduce your triggers:

  • Cover your mattresses and pillowcases with dust mite-proof covers.
  • Dust and vacuum regularly.
  • Wash all sheets, pillowcases, and mattress covers often in hot water.
  • Use special HEPA air filters in your home. These can remove very fine particles from the air.

When should I call a doctor?

In most cases, the postnasal drip is annoying but not dangerous. You should consider contacting your doctor if you have a change in the color, amount, or consistency of the mucus. Notify your doctor right away if you experience any other symptoms like fever, wheezing, or if there is blood in your mucus. If medication does not relieve your symptoms, more testing may be needed.6,7

Author’s note:

I have dealt with sinus/postnasal drip issues off and on frequently throughout the past 20 years. When we develop a cough or a wheeze, we can get alarmed thinking that we may be having a flare-up. It is often challenging to distinguish between the possibilities since often symptoms overlap.

Several published articles that I came across while researching suggested the use of humidifiers, vaporizers, and hot steam for postnasal drip. These suggestions are not suitable for the NTM and/or bronchiectasis patient since NTM is often within the steam mist.

I recommend that people with bronchiectasis and/or NTM follow the routine that works best for them. Remember to check with your doctor before starting any new drug.

We should continue to educate and advocate for ourselves with every medical issue we face. Do not be afraid to ask questions to your doctor. I prefer to be proactive rather than reactive. How about you?