When people think about pulmonary fibrosis (PF), they usually focus on the lungs. But many of the challenges that patients face – such as coughing, congestion, sleep disturbances, and more – don’t always come directly from the lungs. The entire airway system is connected to your lung health in ways we’re still beginning to understand. Learn about the sinuses specifically below, and stay tuned for more educational content about the airway system in the context of pulmonary fibrosis. 

About the Sinuses

Your sinuses aren’t empty cavities; essentially, they are active, living environments lined with mucus-producing cells. The sinuses host a microbiome, or a community of bacteria and other microorganisms that help regulate inflammation, protect against infection, and influence immune responses. 

The nasal microbiome is similar to what we see in the gut and in the respiratory tract (also known as “lung microbiome”). Researchers recognize a broader system linking the sinuses (upper airway), the lungs (lower airway), and the gut microbiome. These systems communicate through:

• Immune signaling
• Mucus production
• Microbial balance

This means changes in one area, like the sinuses, can influence the lungs. For people living with pulmonary fibrosis, this connection may affect:

• Inflammation levels
• Mucus production
• Infection risk
• Symptom type and severity

Why Sinus Issues Can Worsen PF Symptoms

Many PF patients report ongoing throat clearing, persistent cough, and thick mucus or phlegm. Sometimes, this is not coming from the lungs; instead, it’s coming from the sinuses draining downward. This is often referred to as post-nasal drip, and it can irritate the throat, trigger coughing reflexes, or mimic or worsen PF-related symptoms. Conditions like allergies or chronic sinusitis can also play a major role.

Many PF patients experience mucus from the sinuses and the lungs at the same time, which is why managing sinus health can help overall symptoms. It’s not always easy to tell where mucus is coming from. Here are some tips to try telling the difference: 

Potential Sinus-Related Mucus

• Felt in the throat
• Frequent throat clearing
• Worse when lying down
• Often linked with congestion or facial pressure

Potential Lung-Related Mucus

• Feels deeper in the chest
• Associated with coughing fits
• May be harder to clear
• Linked to lung inflammation or infection

Why Researchers Are Studying Sinus Treatments in Lung Disease

You may have seen sinus treatments being explored in clinical trials for pulmonary fibrosis. Researchers have been investigating whether improving sinus health can eliminate nasal oxidative stress, reduce airway inflammation, improve mucus clearance, lower infection risk, reduce coughing, and so on. Approaches being studied include saline rinses, steroid nasal sprays, and antimicrobial therapies. The idea overall is that improving the upper airway may positively impact the lower airway.

Tips for Taking Control of Your Sinus Health 

Here are several actionable strategies to improve your sinus health right now:

Breathing Patterns: Nose vs. Mouth Breathing

One often overlooked factor is how we breathe. Instead of inhaling through your mouth, inhaling through your nose helps:

• Filter particles and pathogens
• Humidify and warm the air before it reaches the lungs
• Produce nitric oxide, which supports airway function and has antimicrobial effects
• Support healthy airflow and pressure in the sinuses

Conversely, mouth breathing may dry out the airways, bypass natural filtration, increase irritation in the throat and lungs, and worsen coughing and mucus production. It can also reduce proper sinus ventilation, which may contribute to congestion and further imbalance in the sinus microbiome. In other words, for people with PF, nasal breathing can help create a more supportive environment for the airways… meanwhile, mouth breathing may worsen irritation and symptoms. 

Even small shifts toward nasal breathing more often can be beneficial. To practice nasal breathing: 

• Focus on breathing through your nose at rest
• Try gentle breathing exercises
• If congestion or allergies make nasal breathing too difficult, try meditating or imagining the air flowing freely through your nose instead

The Surprising Science of Humming

One simple but powerful technique is humming. Humming strongly for several minutes a couple times a day has been shown to increase nitric oxide levels in the sinuses, improve airflow and ventilation, and help move mucus. The gentle vibration created by humming helps open sinus passages and support drainage.

Many community members have reported similar successes by playing harmonica, practicing techniques like pursed lip breathing, and by utilizing respiratory devices like the Acapella. 

Saline Rinses

Saline rinses can help clear mucus and irritants, support sinus balance, and reduce post-nasal drip. Make sure to use distilled water (never tap water) so you are not introducing bacteria into the area while you rinse! 

Humidification and Air Quality 

Using a humidifier in your home or near your bed helps keep airways moist, thin mucus, and reduce irritation. Some people enjoy adding some essential oils to their humidifiers as well. Additionally, try to reduce irritants and allergens in your home:

• Use air purifiers
• Reduce perfumes, artificial scents, and chemicals commonly found in candles, cleaning products, and hygiene items. Remove or replace with hypoallergenic alternatives. 
• Consider plants, ventilation, or other natural ways of improving air quality. Be mindful of environmental exposures such as the amount of smoke in the air. 

Sinus Massage and Acupuncture

Massage areas around the forehead, cheeks, and nose to help improve drainage and relieve pressure. Consider complementary therapies such as acupuncture, acupressure, or lymphatic drainage too. Many holistic practitioners are trained in strategies that can reduce congestion, improve breathing, and reduce symptoms. 

Notice Your Sleep Positioning and Patterns 

The way you breathe in your sleep can make a difference in how you feel during the day. Sleep disturbances and sleep apnea are common for people with PF. Some community members suggest elevating your head by placing books or something similar under your mattress. Especially if you have GERD, avoid laying flat immediately after meals. Staying upright helps reduce post-nasal drip and reflux-related irritation.

When to Look More Closely at Sinus Health

Consider evaluation by a professional if you have chronic throat clearing, persistent congestion, facial pressure, thick mucus, or frequent respiratory infections. These may indicate sinus involvement in your symptoms. An “Ear, Nose, Throat” or ENT specialist may be able to coordinate personalized care along with your pulmonary care team. Talk to your doctor about:

• Nasal sprays
• Allergy management
• Treatment for chronic sinusitis

Why This Matters for PF Patients

Pulmonary fibrosis is complex – but symptom relief often comes from addressing multiple systems, not just the lungs. Supporting sinus health may reduce coughing triggers, improve comfort, clarify symptom sources, and support overall airway health. 

The lungs don’t function in isolation. They are part of a connected system that includes the sinuses. Incremental changes toward improving sinus health and practicing nasal breathing can have a meaningful impact on several elements of quality of life, such as sleep and mental health. Sometimes, improving breathing starts before the lungs.

To discuss with others who can relate, join our community forum and sign up for support group. To take action right now, please consider making a donation or becoming a volunteer. Learn more here.