Introduction

Definition of Nasal Congestion

Nasal congestion (also known as a blocked nose) is a primary symptom of upper respiratory tract disorders. These can include allergic rhinitis (which is nasal congestion caused by allergies such as seasonal allergies), rhinosinusitis (nasal congestion caused by sinusitis) or non-allergic rhinitis (chronic nasal congestion not associated with any allergies).¹

Importance of understanding Nasal Congestion

Nasal congestion is often described as fullness, obstruction, reduced airflow, or being “stuffed up” around the nasal or sinus area.² Nasal congestion can cause sleep impairment due to the inability to breathe comfortably, which can cause daytime sleepiness and reduced productivity.³ Nasal congestion is a symptom that most people try to get rid of as it can also affect their ability to perform daily tasks and can also impact their emotional state.⁴

Overview of nasal sprays as a treatment

Treatments for nasal congestion range from simple irrigation using Sodium Chloride 0.9% solution to antihistamines or topical nasal corticosteroids for more severe cases of allergic rhinitis.

Causes of nasal congestion

Nasal congestion occurs when something or a foreign particle irritates the lining inside your nose, which stimulates your immune system to try to get rid of this foreign particle or to protect other areas of the airways. It does this by increasing blood flow within the sinus which causes swelling and increasing mucus production to increase expulsion. 

Nasal congestion can be caused by a range of things such as seasonal pollen (also known as hayfever), which is more common in the warmer months, and pets. 

Exposure to pets can trigger allergies due to their dander (small pieces of skin or fur that cause allergies).

In addition to allergens that cause nasal congestion, it can also be caused by bacterial or viral infections. Common infections that cause nasal congestion include sinusitis and flu. Sinusitis occurs when your sinus becomes blocked and inflamed stopping the drainage of mucus.

A deviated septum is the most common cause of r nasal obstruction which can cause mouth breathing, snoring and nasal deformity, and can increase the risk of sinusitis. A deviated septum is when the cartilage or bone is not centered which can impact breathing.⁵

Nasal polyps are non cancerous growths are form in your nose or sinuses. Nasal polyps can cause both a runny nose (rhinorrhoea) and nasal congestion. Nasal polyps may also affect your ability to smell.

Dry air may also cause nasal congestion. Dry air can make mucus in your sinus thicker causing it to build up and cause nasal congestion. Dry air can also irritate the lining of your nose and sinus, causing an inflammatory response and nasal congestion.

Types of nasal sprays

There are several nasal sprays that can relieve symptoms of nasal congestion.

Saline Sprays

Saline sprays are a mixture of water and salt, typically Sodium Chloride. Saline sprays mainly work by cleaning, flushing out and lubricating the nasal area to get rid of any irritants that may be cause nasal congestion.

Decongestants 

Decongestants are a common medication used to relieve nasal congestion. They work by constricting blood vessels to reduce blood flow and reduce swelling. Decongestants can be taken orally or can be sprayed topically directly into the sinus for a faster onset of action. Long term use with decongestants over a weel are not recommended and can lead to rebound symptoms. Common decongestants include phenylephrine and oxymetazoline.

Steroid Sprays

Steroid nasal sprays are anti-inflammatory sprays that can be used for mild to moderate nasal congestion. Common steroid sprays include beclometasone, budesonide, fluticasone, and mometasone. These steroid sprays work to reduce swelling, inflammation and reduce mucus production. However, steroid sprays can take around a week for the effects to be noticeable and are often taken a week before you are expected to experience nasal congestion and other nasal symptoms.

Oral steroids may given to you in cases of severe congestion or for nasal polyps. This would be for a short duration as steroids are linked with adverse effects such as thinning of skin and impaired immunity.

Antihistamine sprays

Antihistamines work to reduce itching, swelling and inflammation. The sprays work faster than oral pills and are less likely to cause drowsiness, although it is still possible. The most common antihistamine sprays include Azelastine.

Proper use of nasal sprays

As with every other medication, if you do not use them properly, you will not receive its maximum benefits. It is therefore important to use a proper technique and follow to recommended dosing schedule.

Correct administration technique

Prior to using the spray, blow your nose to clear any mucus. Shake the bottle to ensure its contents are mixed properly. Tilt your head forward and insert the nozzle into your nostril, but not too deep. Aim the nozzle outwards and not inward towards the septum to avoid irritation. As you press the bottle, inhale gently to ensure the spray reaches inside your nose and sinus area.

Potential side effects

As with any medication, nasal sprays can cause side effects. Long term use of decongestant sprays can lead to rebound congestion, where nasal congestion reoccurs once you stop using them, which can cause a constant cycle of overuse. Nasal sprays can cause nasal dryness, irritation, stinging or burning sensations, and coughs if it reaches the throat. Steroid sprays in particular can use thinning of the nasal tissue and reduced immunity.

Summary

Nasal congestion is a common symptom of conditions affecting the sinus and nasal cavity and can impact your daily life. It can be caused by allergens such as pollen or dander from pets along with other allergens, infections such as sinusitis and flu, a deviated septum, and nasal polyps. There are many medications available to provide relief. These can include saline sprays and decongestants for mild congestion and steroid or antihistamine sprays for more moderate symptoms.

Proper technique is vital to get benefit from these medications so it is useful to consult your doctor or pharmacist to help you learn techniques, and ensure to read any information leaflets that come with your medication.