Nasal Congestion? Medicine not helping?

Are you or a family member struggling with one of allergy’s most aggravating symptoms? Sometimes our noses work too well. If it doesn’t like what you’re breathing, it does its best to protect you. A congested, runny nose is a body’s way of trying to block out or rinse out the particle/offender. The following is a list of treatments that help with the aggravating symptom of congestion:

  1. Nasal steroids-Nasal steroids are one of the most effective treatments when it comes to congestion. They all require a prescription, and their peak effect comes with several weeks of use. The safety profile is excellent with appropriate use. There can be side effects, though. Nose bleeds and nasal irritation can occur. On rare occasion, someone can develop a perforated septum which is a hole in the tissue dividing the two sides. They can also affect the pressure inside the eye which can be an issue for someone with glaucoma. Remember, they are steroids but  are delivered in microgram quantities and are not likely to cause long term issues the way milligram doses of oral steroids can.
  2. Nasal antihistamines-Nasal antihistamines also are effective for nasal congestion. Most nasal antihistamine studies show a noticeable benefit in congestion in as little as 30 minutes. They can also have an additional benefit when added to nasal steroids.  Like nasal steroids, these are also available only by prescription. They are not as likely to cause nose bleeds compared with nasal steroids and do not affect the pressures inside the eye.
  3. Oral decongestants-Oral decongestants like pseudoephedrine and phenylephrine are effective in treating nasal congestion. Pseudoephedrine is available behind the pharmacy counter without a prescription. For adults, it comes in short-acting 30mg pills as well as longer acting formulations that have up to 240mg in them. They can be found in a tablet by themselves or in combination with antihistamines or guaifenesin. The main issue with oral decongestants is their side effects, as they are stimulants that can raise blood pressure, increase heart rate and cause insomnia.
  4. Nasal spray decongestants-Nasal decongestants are the payday lender of nasal sprays. You can get quick relief but you’ll pay for it later with continued use. They constrict blood vessels in the nose and can provide a rapid improvement in congestion. If used more than three days, rebound congestion develops when the medicine wears off that can be worse than the initial congestion. These sprays can be addictive and lead to damage to your nasal tissue. It’s called rhinitis medicamentosa and occasionally needs steroids to help break the cycle. I have a bottle in my medicine cabinet. When I have a cold and wake up congested in the middle of the night, I’ll go for the rapid relief so I can get right back to sleep.
  5. Hypertonic nasal saline-Hypertonic nasal saline has a greater salt concentration than isotonic saline. It can have a very mild effect on nasal congestion.
  6. Surgery-If you’ve exhausted all the options above or have medical issues that narrow your choices, you may want to consider looking into an anatomical issue. For some a deviated septum or severely swollen nasal turbinates despite medicines will require an evaluation with an ENT. A septoplasty or a turbinectomy may be the answer rather than medicine. For kids, the blockage may not be the front portion of the nose but swollen adenoid tissue in the back of the nose.

You may ask, “What about oral antihistamines?” They are not on this list. By themselves, oral antihistamines do not treat congestion. That is why most are sold in combination with pseudoephedrine as a “D” option.

Spring is here. Talk with your doctor about what you should take to keep congestion from slowing you down.

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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.


2 responses to “Nasal Congestion? Medicine not helping?

  1. What do you do if you’ve had sinus surgery twice already, and still have extreme congestion, with nothing really helping?

  2. You need a good ENT to steer you in the right direction. They would need to check for polyps or scar tissue. Polyps are stubborn and have a high recurrence rate. It’s often a team approach with an ENT managing the anatomical issue and possibly an allergist to help manage the underlying reason for the inflammation.

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