Ann IM 1993;119:977

Cause:Postnasal drip from chronic sinusitis; asthma, allergic bronchitis and/or rhinitis; gastroesophageal reflux; COPD; medications, esp ACE inhibitors

Si:Methacholine challenge test positive if asthmatic origin

Xray:Sinus films, chest xray

Rx:

make dx first, then pick tx appropriately; stop ACEIs and smoking; rx of asthma or GE reflux if either present

1st: Decongestant/antihistamine bid, helps 39/45; perhaps w codeine or dextromethorphan (Med Let 2001;43:23)

2nd: Nasal steroids bid

3rd: Albuterol inhaler; or terbutaline 2.5 mg po tid or inhale, cures 2/3 (BMJ 1983;287:940); or aminophylline, and a po -agonist like terbutaline