The first robin, the first crocus, and the first pitch thrown on opening day are all sure signs of approaching Spring, heralding the arrival, for many, of nasal and sinus congestion.
by Joe Goldstein, R.Ph.
Last night I received a phone call from a friend, and made plans to meet with him next week. In the course of our conversation he mentioned he was suffering from “sinusitis”. Sinusitis is a generic term that means the spaces in the bones around the nose are inflamed. The “itis” suffix on the word indicates inflammation. Don’t confuse this with the ending “itus”, which indicates a condition. Pruritus, for example, means itching.
My friend Mark told me his sinusitis would soon be gone, when the weather here stabilizes. Sinusitis may be acute or chronic, and may be confused with a cold, which is a viral infection caused by a rhinovirus (“rhino” means nose). It may also be a bacterial infection, or a seasonal or other allergy, or a reaction to an environmental irritant, such as smoke. Most of the time it’s okay to self-diagnose and self-treat sinusitis, but always remember thePassionatePharmacist’s mantra: if it’s not significantly better after three days of self-treatment, then it’s time to seek medical attention. While sinusitis is usually not serious, sometimes it may need medical, or even surgical, intervention. Sadly, sometimes the treatment can be worse.
Mark told me he was using Afrin nasal spray. Afrin was the first and best known brand of a drug called oxymetazoline, a medication that dilates, or expands, the sinus and nasal passages. This allows mucus and pus to pass more feely. This drug is very efficient, and very useful. Another similar drug, phenylephrine, is also effective. It’s more commonly known as Neo-Synephrine. Both are easy to use, and safe if used according to directions.
These products should not be used by people who have high blood pressure, heart disease, stroke, diabetes, glaucoma, or thyroid disease unless their use has been okayed by a physician, and under a doctor’s supervision. These medicines can cause worsening of these diseases. These precautions are clearly stated on the packages. The labels also offer the following caveat: do not use more often than twice a day, and for not more than three consecutive days. Overuse of these sprays or drops can lead to a condition called rebound congestion. The nasal and sinus passages become more inflamed and narrowed. Breathing becomes more difficult, so people use them more than twice daily, because they can’t breathe without it. It’s really developing a drug tolerance. The more you use it, the more you need to use to get the same effect. People need to be withdrawn from these drugs, which is a slow and uncomfortable process.
What else can be done to relieve and treat sinusitis? Since it is an inflammation, can oral anti-inflammatory drugs such as ibuprofen and naproxen help? The answer is a qualified “maybe, but not likely”. While these drugs do relieve inflammation and pain, they would need to be taken in doses that might be harmful, so the risk of using them would outweigh their benefits. So what else is there?
Sinus infections need to be properly diagnosed. If you have a bacterial infection, it is likely you will need an antibiotic. Take the one your doctor prescribes today. Don’t use the one that you took for a few days when you had an infected fingernail, and then saved the rest for when you might need them. Taking the wrong antibiotic could delay proper treatment and cause complications, in addition to making your infections resistant to future therapy.
If you are reacting to smoke, perfumes, or other environmental stimulants, removing yourself from that environment can often relieve your symptoms. Steroid nasal sprays are helpful in treating this, as well as other types of sinusitis. As always, follow package instructions. Over-the-counter (OTC) steroid nasal sprays can be accidentally sprayed into the eyes. Be careful! Steroid nasal sprays can increase blood sugar in diabetics, and increase your eye pressure. Report any changes in vision, or elevated blood sugars to your doctor.
ThePassionatePharmacist likes to start with something very simple: saline (salt water) nasal spray. It really is a moisturizer for your nasal passages, but does a very good job of relieving congestion. I first gently blow my nose to initially clear the passages. I do that before using any nasal spray. I also buy commercially prepared spray. There are many formulas online for preparing your own saline solution, but I think the ready-made sprays are well worth the minor cost. The original saline nasal spray was called Ocean (clever, right?), but most other brands (e.g. Ayr) and generics will work as well. I keep my head upright and sniff up as I spray once into each nostril to get the spray as high up into the passages as possible. I then wait a minute and repeat the process: blow, spray, sniff. I feel comfortable doing this whenever I get stuffy, whether it’s every three hours or every 12 hours. Nasal saline is safe.
Sinusitis from environmental irritants and from seasonal or other allergies can often benefit from the use of antihistamines. I take a non-sedating antihistamine tablet every day, and I believe it minimizes any symptoms I may have. I have been tested and found to be allergic to Timothy, a common lawn grass. While taking an antihistamine I can walk across a freshly-mowed lawn without any suffering. I rarely have allergy symptoms, even during the days of the highest pollen counts in the air. Check with your doctor or pharmacist to know which antihistamine would be the best for you. Antihistamines are not without their precautions. They are very drying, and could be a concern in men with prostate problems, or people who have difficulty urinating or fully emptying their bladders. Some antihistamines can adversely affect patients with glaucoma. They may cause drowsiness, blurred vision, and difficulty driving or operating machinery. All this should be discussed with your healthcare practitioners.
So welcome the Spring and summer, and enjoy the good weather when you first see that crocus, or hear the crack of the bat and cheers of the crowd, or see your first rockin’ robin. Don’t let sinusitis get in your way. Go sox!