Nasal Congestion

The Secret of Great Health Care

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Nasal Congestion

Inflamed blood vessels in the nose causes the nasal passages to swell leading to a sense of stuffy nose, facial pressure, post-nasal drip, cough, sore throat and runny nose.What causes nasal congestion

Sinus infections
Allergies
Viral illnesses – the common cold
Pregnancy

Who needs to go to the doctor

Nasal congestion is a common complaint that can most often be managed by time, home remedies and some over-the-counter medications.

When nasal congestion lasts beyond 7-10 days without much improvement than there is possibility that there is a sinus infection. Going to the doctor would best suit these individuals. Individuals who do not have one of the red flags listed below and have had nasal congestion that has persisted less than 7 days likely do not need a doctor.

The following people should see a health care provider if they are afflicted with nasal/sinus congestion and any of the following symptoms:

Swelling of the forehead or around the eyes

Inability to move the eyes

Confusion

Decreased sensation over the face

Bonus: How to Evaluate Nasal Congestion

What is the risk

Most cases of sinus congestion will go away on their own. Some cases have the potential to lead to major problems. Any of the factors in the above section "who needs to see the doctor" are potentially situations that could lead to major problems.

Many people with nasal congestion have the common cold.

Risk Factors for the Common Cold

Daycare attendance

Young age. The young child has an immature immune system. It is not that unusual for young children to have 8-12 colds a year.

Day care attendance

Old age. Older adults have a decreased cough and gag reflex and an immune system that does not work as well

Certain disease states such as cancer, HIV and diabetes

Conditions that require you to be on medications that suppress the immune system such as prednisone

Travel on buses, planes or in crowded conditions

Psychological stress

Excessive exercise

Low vitamin D level

Winter season. Viruses survive better in low humidity environments

Treatment
Treatment needs to focus on improving symptoms. People with a common cold can be quite miserable. Getting rest and plenty of fluids should be encouraged to allow the body to heal. Fluids will help prevent dehydration and may help thin the mucus.

Nasal saline is a product that helps clear mucus out of the nose. Sore throat can be treated with oral pain relievers, salt-water gargles or a variety of over-the-counter throat products. No product is a magic bullet, but many can provide some relief of throat discomfort.

Most colds follow a three to five day pattern. While the individual feels quite bad the first few days, by day three there should be significant improvement and by day five the patient should be almost completely well. Nasal congestion and cough is not unusual beyond five days, but the patient should be feeling better than the first three days.

The most important part of treating a cold is to provide the person with rest and fluids. During the first two to three days of the cold those afflicted should take as much rest as possible. The child should be given extra attention during this time. Fluids will help with hydration, soothe a raw and irritated throat and will help loosen congestion.

Cool mist humidifiers and steam from showers can help with congestion. Caution should be used in those who have asthma as those with asthma risk a spasm to the breathing tubes with a change in humidity.

Encouraging children to sleep on their sides may provide more restful sleep instead of sleeping on the back. Sleeping on the back increases the amount of mucus that drips into the throat and chest, which will predispose to coughing and a sore throat.

A multitude of over-the-counter medications can be used to provide relief while the body fights off the infection. Depending on the primary symptoms that are giving you trouble, you may want to select an agent that will help treat those symptoms (see the symptom chart at the end of this chapter).

Medicines that bring down fever are also effective at improving pain and body aches. If these symptoms are bothersome the use of acetaminophen, aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful.

Antihistamines are helpful if you are bothered by runny nose, sneezing and itchy eyes, nose and throat. The first generation antihistamines are more effective at controlling these symptoms than the second-generation antihistamines. Side effects of the antihistamines may be more bothersome than the benefits are beneficial, so antihistamines should be used with caution. Antihistamines are generally not recommended for sinus infections.

First-generation antihistamines include medications such as diphenhydramine (Benadryl). Second-generation antihistamines include medications such as loratadine (Claritin) and cetirizine (Zyrtec).

Decongestants either topical or oral – can help with nasal congestion. Adults benefit for up to five days with the use of decongestants to a modest extent but children younger than 12 have not seen the same benefit as adults.

There are three levels of nasal decongestants.

Oral medications
Topical medications
Vapor medications

Oral medications are pills taken by mouth. Examples include pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). These medications work by constriction blood vessels in the nose. One unfortunate side effect is that they constrict vessels not only in the nose but also all over the body. Therefore, they can increase blood pressure and should be used by caution in anyone with heart disease, high blood pressure, any other cardiovascular condition in addition to diabetes, thyroid problems, or prostate problems.

Topical decongestants can also be used to unblock the nose. These are medications that are sprayed directly up the nose and act locally. Unfortunately, some of the medication can leak into the blood and act systemically. This means that topical medications can also increase blood pressure. Therefore, the same risks associated with oral decongestants apply to the topical decongestants.

The other major complication of topical decongestants is rebound congestion. The use of topical decongestants for more than three days can lead to congestion that becomes difficult to break up without persistent use of the same topical decongestants. Therefore, only use topical decongestants for three days.

Vapor decongestants are not as potent as the other two brands of decongestants, but are the safest medications to use in those with heart disease.

Antitussives (such as over-the-counter Robitussin - DM) can be used to quiet cough, but in the common cold the best strategy to reduce cough is the use of antihistamines and decongestants.

To purchase products discussed in this chapter visit The Drug Store.

Antibiotics should not be used for the common cold, unfortunately they often are. Antibiotics – while they may appease the person who goes to the doctor for the cold – do not enhance illness resolution. Upper respiratory tract infections are the second most common reason antibiotics are prescribed each year.

Another common misconception is that antibiotics will prevent a cold from becoming a sinus infection. This is not true.

Over-the-counter medications have been thoroughly studied in adults, but these medications have not been studied as well in children. New labeling laws have recommended that the use of many over-the-counter medications be limited in children under the age of 4-years-old. Many of the complications resulting from over-the-counter medication use in children have been from incorrect dosing. Caregivers need to assure proper doses when giving medications to children.

Natural Treatment for Sinus infection

Some people like a natural cure to sinus infections. Check out How to Cure a Sinus Infection. It is a more natural way to relieve sinus infections instead of antibiotics, decongestants and medicated nasal sprays.

Antibiotics for Acute Sinusitis

Most patients with sinus infections have a viral sinusitis and will not derive benefit from antibiotics, but there are times that antibiotics are helpful. Unfortunately, antibiotics are a very common prescription given to patients for colds.

When symptoms persist beyond 10-14 days bacteria may be causing some of the symptoms and the use of antibiotics may resolve the infection. Some patients may actually clear their infection without the assistance of antibiotic even if symptoms have persisted beyond 10-14 days.

Adults who have mild symptoms such as mild pain and a fever of less than 101 degrees Fahrenheit may be treated with close monitoring and symptom management instead of antibiotics.

In the typical cold improvement should be noticed in 3-5 days with complete resolution by day 12.

Symptom Chart

What is your symptom?	Helpful intervention	Helpful medication	May be helpful
Sore throat	Fluids, cool mist humidifier, salt-water gargles	Nasal saline	Throat lozenges/sprays
Stuffy nose	Fluids, cool mist humidifier	Nasal saline	Decongestants
Runny nose	Fluids, cool mist humidifier	Nasal saline	Antihistamines
Headache	Rest, cool compress on the head	APAP, NSAIDs
Fever	Fluids, dress in light clothes	APAP, NSAIDs	Sponge bath
Body aches	Rest	APAP, NSAIDs
Earache	Warm wash cloth over the ear	APAP, NSAIDs	Decongestants
Face/sinus pressure	Fluids, warm wash cloth over the face	APAP, NSAIDs	Decongestants
Cough	Fluids, cool mist humidifier	Nasal saline	Guaifenesin or dextromethorphan
Sneezing	Avoid allergens	Nasal saline	Antihistamines

APAP – acetaminophen

NSAIDs – non-steroidal anti-inflammatory drugs (ibuprofen, naproxen)