A stuffy nose is more than just an uncomfortable nuisance. Blocked nasal passages promote the growth of bacterial sinus infections, and mouth breathing increases the risk of throat and lower respiratory infections. There are multiple options for treating a stuffy nose, each with advantages and disadvantages.
Allergies and viral rhinitis (colds) cause similar nasal symptoms. Oral decongestants and antihistamines are popular for both. But all oral drugs have systemic side effects and may interact unfavorably with other medications. Nasal sprays offer a way to get maximum benefits to the nose with minimal effects on the rest of the body.
There are six classes of nasal spray, some available over-the-counter and others by prescription:
1. Decongestants, including many over-the-counter options. These work by constricting the blood vessels in the nose.
2. Cromolyn, available over-the-counter as NasalCrom or generic products. This chemical stabilizes mast cells, so they do not burst and release histamine. It should be started several weeks before allergy season.
3. Saline solutions. Formulations are available over-the-counter with various herbal ingredients, and offer some benefit with excellent safety.
4. Antihistamines, including Astelin (prescription only). These work by blocking histamine receptors. Reference 1 recommends Astelin for exceptionally wet noses.
5. Anticholinergic agents, including Atrovent (prescription only), which is used primarily for bronchial spasms.
6. Corticosteroids, including Flonase, Nasonex, Nasarel, Nasacort, Vancenase and Rhinocort (all prescription only). Corticosteroids are powerful anti-inflammatory drugs.
According to Dr. Frank K. Kwong, over-the-counter decongestant nasal sprays are excellent emergency options if you really need your nose fixed for an important performance, or an airplane trip, or for a doctor to examine the nose and sinuses. They work quickly and effectively, but manufacturers warn against using them for more than three days at a time. Longer use produces a dependency, which is sometimes called nasal spray addiction.
Last week I started a generic cromolyn nasal spray, which requires one to two weeks to take effect. For years I used oral pseudoephedrine (Sudafed), which worked beautifully. Unfortunately, I developed breathing problems. I felt like something was tied around my chest, and I could barely pull the air in. My chest muscles hurt. I checked the Internet for Sudafed side effects and sure enough, I found breathing problems and chest pain on the list. So I switched to a generic phenylephrine nasal spray. It has the same symptoms but they are not as intense and still not acceptable. So I decided to give cromolyn a try. It's frustrating to use something for a week before getting results, but my nose is improving now. I'll give it another week and then decide whether to ask for a prescription variety.
Most prescription nasal sprays are steroids, which have a mechanism of action different from the decongestant and cromolyn options. They require a few days to take effect, but many of them can be used for longer periods of time. They're not perfect either; the Flonase web site reports possible side effects as headache, nosebleed and sore throat. Different people get different results from any drug, so it's worth knowing that there are multiple options.
References:
1. Frank K. Kwong, M.D., “The Complete Allergy Book”, Sourcebooks, Inc., 2002.
2. Nasal spray addiction:
http://www.mayoclinic.com/health/nasal-spray-addiction/AN01241/rss=2
3. Flonase corticosteroid prescription nasal spray:
http://www.flonase.com/
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.