Monthly Archives: April 2012

Upper Respiratory Congestion

Upper respiratory congestion,due to inflammation of the nose (rhinitis), sinus (sinusitis), and throat (pharyngitis) can be felt as nasal/ sinus/ throat “fullness,” congestion or pain. It seems to be a complaint of patients felt throughout the year. And why not. The lining of our nose, sinuses and throat are sensitive to many irritants present in our everyday environment throughout the year.
Most often a patient sees their doctor in search of an antibiotic for a suspected bacterial infection causing the symptoms.  Actually, viral infections and allergy account for more of these bothersome symptoms, and recognition of this can provide symptom relief faster and less expensively by use of over the counter (OTC) medications. 
Viral infections by the rhinovirus is the most common cause of “cold” symptoms.  These occur most often in the late fall and winter, and consist of  the sensation of fullness in your head, around the eyes (where the sinuses are located), and in the ears and throat.  When the throat lining gets swollen, the throat opening of the Eustachian tube from the middle ear gets blocked and the pressure from it can’t be equilibrated easily. This is the same pressure you may feel in an elevator of a tall building or  in an airplane.  Also your eyes may tear and your nose may “sniffle.”
A rhinovirus infection is usually picked up when we casually touch our eyes, nose or mouth after picking up the virus from a non-absorbable surface after an infected individual sneezed or coughed on it.  This is why handwashing is so important in prevention of most viral and common bacterial infections.  We have no effective antiviral medication to treat the common cold virus yet.  Other general “good health” habits such as eating a balanced diet, getting enough sleep, exercising regularly, and effectively managing stress  will aid in the prevention and treatment of a “cold.”
OTC medications which may help, include guaiafenesin which helps loosen secretions and helps the body get rid of the virus particles. You want them to “flow out” of the body to keep them from multiplying and getting into your bloodstream   and thus compounding the symptoms.  Guaiafenesin is present in some liquid cough meds as well as in timed-released and regular tablets.  Although it carries the warning of possible stomach upset, it is usually well-tolerated by most people and should be used whenever there is mucus that you want to get rid of.
Sometimes guaiafenesin is partnered with an antitussive (anti-cough) medication.  This is mostly for the purpose of patient comfort, for example to allow them to sleep.  Using the antitussive all the time is counterproductive; you’re loosening the secretions/mucus but stifling the cough to get rid of them!   In addition the cough suppressant medication can upset the stomach and cause constipation. So maybe taking the anti-tussive/guaiafenesin during the night, and the plain guaiafenesin during the day would make sense.
Decongestant medications are available OTC but you may have to show your ID card in order to purchase them since they may be abused.   Phenylephrine and pseudoephedrine  come in pill form, both timed-release and regular release. Patients with hypertension should exercise caution with these meds; they may elevate the blood pressure.  They can also cause insomnia and increased pulse rate so the afternoon/evening dose may need to be modified or skipped.  Your doctor will be able to advise you on this.  
Nasal decongestant sprays/gels are also available, may work faster, and you may be able to modify the dose.  But follow the instructions carefully since some decongestants can worsen symptoms if used for more than a few days.
One caveat: Although most viral infections clear up eventually,  they can sometimes linger, weaken your immunity and open  the door  to a bacterial infection.  It should be recognized  that bacteria exist normally in the throat and nose, but are kept “under control” by good health.
Allergic rhinitis, on the other hand, causes similar symptoms  as rhinovirus infection but in addition there are histamine-related symptoms of itchy eyes, itchy nose, itchy throat and multiple sneezing (4-5-6 times in a row).  Any one of these histamine signs, expecially when there are more than one, should make you think “probable allergy” as the cause.  The importance of this is that anti-histamines are available OTC and are effective  in relieving symptoms and, more importantly, preventing development of a secondary bacterial infection.
Loratadine is the generic of Claritin, cetirizine is the generic of Zyrtec, and fexofenadine is the generic of Allegra.  The generics are all available OTC and generally do not have the side-effects of diphenhydramine (Benadryl). These are sleepiness, dry mouth, and prostate congestion in men.  However, if you have to take the antihistamines regularly, you may eventually experience some side-effects .  If you have a history of asthma consider using guaiafenesin while on antihistamines to help prevent bronchial plugging from dried mucus secretions.

Some patients have reported decreased effectiveness of the antihistamines after prolonged use.  When this effect has been seen, another one is chosen.  
Although we commonly think of allergic rhinitis  as occurring in the springtime, these histamine symptoms can also happen in the middle of winter!  If you get those itchy histamine symptoms in January, you may be reacting to indoor allergens  such as animal danders, dust mites, or allergens on your clothes from walking outside.  One study suggests that if you have a history of allergic rhinitis in the spring, you are more susceptible to allergic sensitivity in the winter.  So watch for it; use the antihistamines as directed.  Having had the “opportunity” of experiencing allergic rhinitis in the winter, I can appreciate how insidiously it can appear in the middle of winter, make you think you have a bad cold or bacterial sinus infection, and make you think you need an antibiotic. But check your history carefully; antihistamines may help and antibiotics can be saved for when you really have a bacterial infection.
Your physician will help you with any further questions about rhinitis, sinusitis or pharyngitis, including other, less frequent causes for it. His/her experience may even contribute further insights to help  maintain your good health!