Addiction. No doubt
you’ve heard of the opiate crisis, where people become dependent on pain-killer
drugs. But did you know your nose can
become addicted to drugs as well? And to
run-of-the-mill, legal stuff available over-the-counter (OTC)?
Most folks suffer a congested nose more than once in their
lifetimes. The causes are varied,
ranging from the common cold to allergies.
Nasal congestion is a stuffed or plugged nose, with blockage of nasal
airflow.
Aside from a mechanical obstruction from an abnormal nasal
mass or altered nasal anatomy such as a deviated
septum or nasal
polyp, most causes of nasal congestion are temporary, a result of
swelling of the soft tissues normally found in the nose. The nasal passages are lined by layers of
cells called the mucosa overlying a soft submucosa, rich in small
blood vessels and capillaries. This
abundant blood flow helps keep nasal tissues moist and warm, which in turn
transmits that moisture and warmth to the inspired air running through the
nose.
However, the mucosa and submucosa can hyper-function. Usually this is a result of exposure to
airborne irritants such as dust or chemicals, allergens or infectious agents
such as viruses. The nasal tissues
become overly swollen and engorged (congested), causing them to secrete too
much. This creates the nasal plugging
the need for frequent nose-blowing.
Decongestants are medications designed to reduce
nasal congestion and to improve nasal breathing, and can be done either with an
oral medication (i.e., pseudoephedrine or phenylephrine) or by direct
application with a spray. There are a
variety of OTC nasal sprays that work in different ways. One particular type of spray is called a nasal
decongestant spray.
Nasal decongestants shrink the mucosa by a process of vasoconstriction. Vaso = vessel and constriction = narrowing or
shrinking the diameter of the vessel.
Hence, the blood vessels that supply the nasal tissue become narrowed to
decrease blood flow to the target tissues when a decongestant is used. The benefit of a nasal decongestant spray is
the near-immediate onset of action, usually within minutes, since it is applied
directly to the mucosa.
Other sprays don’t have quick-onset relief. Nasal steroids such as fluticasone (Flonase®)
or triamcinolone (Nasacort®) often take two weeks to achieve maximal effect and are
meant for regular rather than as-needed use.
Chromium sodium (NasalCrom®) is a preventative allergy spray, not
meant to relieve symptoms immediately, but used prior to your peak allergy
season or in prior to situations where you might be exposed to allergens (i.e.,
going to someone’s house with cats, if you’re allergic to cats). Nasal saline is a salt solution
similar to what you normally produce in the nose, but is meant to help cleanse
and moisturize and not decongest the nose.
Due to their vasoconstrictive properties, nasal decongestant
sprays also help with nosebleeds. We
actually use these in the office, the E.R. and the O.R. for such purposes, or
to minimize intraoperative bleeding during nasal and sinus surgery.
So nasal decongestants are great drugs for immediate relief
of nasal congestion or nosebleeds. But
like a lot of drugs, there is a downside.
I’ll put it out there boldfaced and in large font:
BEWARE!!!: These sprays are meant for short-term use
only. DO NOT USE FOR MORE THAN THREE (3)
DAYS IN A ROW! I repeat—NOT MORE THAN 3
CONSECUTIVE DAYS!
The reason for the excitement? Prolonged use of these sprays can lead to rhinitis
medicamentosa, also known as rebound congestion, where the nasal tissues no
longer respond as well to the decongestant spray, becoming congested shortly
after the vasoconstriction wears off.
Often the congestion from rhinitis medicamentosa is worse than the
initial congestion which prompted the use of the spray in the first place. People then become dependent on these sprays,
using more frequently, as the duration of decongestion shortens.
In essence, they’ve become “hooked” or “addicted” to the
spray, terms used by the very people who present to the office with this
problem. It’s also a travesty that some
sprays on the market (with a variety catchy trade names) containing these
ingredients provide no such warning on their packaging.
Yet, it’s difficult to stop these sprays cold-turkey. Like smoking or opiates, it’s a habit that’s
hard to break. One means to treat this
problem is to gradually wean off the spray.
The following is a plan to slowly taper off the nasal spray.
It consists of progressive dilutions of
the nasal spray with saline solution as follows:
1. Mix 3/4 nasal
spray and 1/4 saline and use this for 1 week.
2. Mix 1/2 nasal
spray and 1/2 saline and use this for the second week.
3. Mix 1/4 nasal
spray and 3/4 saline and use this for the third week.
4. After this,
completely discontinue the nasal spray use or use 100% saline, which helps the
nose anyway.
Saline can be purchased OTC at most stores and
pharmacies. Some brand names are Ocean
Spray, Ayr or a Neil Med kit that comes with a bottle and packets
of powder you mix yourself into clean water.
You can also make your own nasal saline solution with simple ingredients
(see Nasal
Irrigation Instructions for a recipe for making your own saline
solution)
You should also use a nasal steroid spray as directed on a
daily basis while you’re tapering off the nasal decongestant spray. The nasal
steroid spray, as mentioned before, can take up to 2 weeks to achieve
noticeable improvement, so continue using it daily. Your physician may also prescribe a short
course of steroid pills which can have a shorter onset of action (often within 24
hours) to help alleviate your congestion during your weaning process.
Take heart. There is
hope for those whose noses have become addicted to decongestant sprays, even after
years of use. Of course, the best remedy
is not to get hooked in the first place.
So keep to the front of your mind the big-time warning in big-time
letters above.
©Randall S. Fong, M.D.
For more topics on medicine, health and the weirdness
of life in general, check out the rest of the blog site at randallfong.blogspot.com
Comments
Post a Comment