Help Patients Treat Nasal Congestion

Tis the season for the dreaded sinus congestion, with pain and pressure in the face and head that can be unbearable. Fortunately, a plethora of options can provide relief.

Sinus Anatomy

Sinuses are hollow spaces of the skull and face bones around the nose. There are 4 pairs of sinuses that are collectively called the paranasal sinuses¹:

• Ethmoid sinuses: located on either side of the bridge of the nose near the eyes
• Frontal sinuses: located above the eyes near the forehead
• Maxillary sinuses: located on either side of the nose near the cheekbones
• Sphenoid sinuses: located behind the eye set deeper into the skull

Causes of Sinus Congestion

Nasal congestion occurs when the sinuses become clogged and/or inflamed. The most common causes of congestion are minor illnesses, such as the common cold, influenza, and sinus infections. If congestion lasts longer than 2 weeks, it could signify an underlying issue.²

Nasal irritants can also induce congestion. Allergens, such as animal dander and pollen, trigger a histamine reaction that results in excess mucus production. Exposure to irritating chemicals, such as bleach and other cleaners, can have the same effect. Environmental irritants, such as dust mites, smoke, and even changes in the weather, are all possible triggers.²

Some anatomical abnormalities can cause congestion as well. These can include concha bullosa, deviated septums, enlarged adenoids, inferior turbinate hypertrophy, and nasal polyps or tumors.²

Symptoms of Sinus Congestion

Symptoms of congestion include pain and pressure located at the area of the affected sinuses. Headaches, toothaches, and pain or pressure behind the eyes or under the cheeks are also symptoms. Illness or inflammation can also cause excess mucus production, which can be hard to expel because of inflammation. A feeling of fullness in the face can also indicate sinus congestion.

Finding Relief

Antihistamines

Antihistamines work by blocking the body’s response to allergens. This results in less inflammation and less mucus production. Antihistamines come in different formulations. Some last 4 to 6 hours, and others last 12 to 24 hours. Some antihistamines, such as chlorpheniramine and diphenhydramine, cause drowsiness. Some do not cause drowsiness, such as cetirizine, fexofenadine, and loratadine. Older individuals and young children are particularly susceptible to the toxicities of antihistamines. Therefore, children younger than 4 years should not take antihistamines without a pediatrician’s approval. Older individuals should use antihistamines with caution.

Decongestants

Decongestants work by constricting blood vessels, which leads to less inflammation and thinner mucus. This, in turn, leads to relief of sinus pressure. Nasal decongestants, such as naphazoline, oxymetazoline, and phenylephrine, are also good for congestion caused by cold and flu but may cause bloody noses, dizziness, restlessness, and sore throats. These should not be used for more than 1 week. Oral decongestants, including phenylephrine and pseudoephedrine, are best for congestion caused by cold and flu but may cause anxiety, dizziness, and restlessness.

Some individuals should not take decongestants, including those with diabetics, hypertension, hyperthyroidism, and prostate issues.

Steroids

Steroidal nasal sprays work by reducing the immune response, leading to decreased mucus production and less inflammation. They also act directly to decrease inflammation. A steroidal nasal spray works best when it is used every day. Steroids may take up to 2 weeks to be completely effective. These nasal sprays are available over the counter or by prescription. Adverse effects include bloody noses, headaches, nasal irritation, sneezing, and sore throats. Nasal corticosteroids are good for hay fever and allergies and may cause drowsiness.

Home Remedies

Myriad remedies exist for finding relief from congestion that do not include medication. The primary at-home treatment involves keeping the sinuses moist. This can be done by breathing in steam or using a humidifier, neti pot, or saline nasal spray. Keeping the sinuses moist thins the mucus, making drainage or removal easier.³

A neti pot is a nasal irrigation device designed to flush mucus from the nasal cavity. Neti pots are good at removing mucus and reducing inflammation, and they must be used with an irrigation solution. To make this solution, use distilled or filtered water. Using tap water may increase the risk of infection. Neti pots must be cleaned well after each use.³

Another home remedy is to place warm compresses on painful areas of the face. This warmth helps reduce inflammation and thin mucus.3 Another useful tip is to drink fluids, especially warm ones, including, soup, tea, or water. Staying hydrated helps thin mucus and relieve inflammation and pain.³

Additionally, it is important for patients to know their triggers so that they can be proactive with their medications and hopefully not become congested at all. Taking allergy medication prior to allergen exposure or using a nonsedating antihistamine regularly during allergy season helps reduce the need for congestion relief.

When to Contact a Physician

Refer patients to their physicians if congestion lasts for more than 2 weeks because this may be a symptom of an underlying condition. If congestion is accompanied by a fever lasting more than 3 days, it could indicate an infection that may require antibiotics. Also recommend contacting a physician if patients have comorbidities such as asthma, emphysema, or a weakened immune system because these conditions can worsen quickly without appropriate treatment.

Role of Pharmacists

Patients often ask for recommendations at the pharmacy counter. Pharmacists have the knowledge to determine which medications patients should take based on their health conditions and symptoms.

There are so many cold remedies, many of which have several active ingredients, so it can be overwhelming. Recommending the right medication can keep patients feeling well and functioning.

References

1. Hecht M. Sinus anatomy, pictures, and health. Healthline. Updated August 12, 2019. Accessed November 29, 2022. https://www.healthline.com/human-body-maps/sinus-cavities

2. Moore K. What causes a stuffy nose? Healthline. Updated August 2, 2022. Accessed November 29, 2022. https://www.healthline.com/health/nasal-congestion

3. Sinusitis. NHS Inform. Updated November 28, 2022. Accessed November 29, 2022. https://www.nhsinform.scot/illnesses-and conditions/ears-nose-and-throat/sinusitis

About the Author

Kathleen Kenny, PharmD, RPh, is a clinical medical writer for Healthline Media in Colorado Springs, Colorado.