A look at how and why to use nasal sprays

Nasal asthma. Ever heard of it? Probably not, because I just made it up. Before you thumb your nose at the idea, consider that the nose and lower airways are all part of the respiratory pathway and share similar immune responses to allergens, irritants and viruses. And while it is possible to have one condition without the other, for many of us, nasal symptoms (rhinitis) usually herald the onset of asthma symptoms to come.

Sure, asthma is a potentially life-threatening condition and rhinitis is not, but mucus plugging is also common to both. In the nose, a mucus plug is dislodged with a hearty blow into a hanky — or it may slip out the back way, down the back of your throat. Eh hem.

In the lungs, all it takes is a droplet of the thick stuff to block vital breathing passages. Resulting coughing spasms slam mucus blockades from the small airways to the larger ones and eventually into your throat where you either swallow it or spit it out.

Even the idea of using topical medications, sprays to reduce or prevent inflammation, is common to the treatment of both asthma and rhinitis. In most cases, using a small amount of medication on the affected area is greatly preferred over using a larger dose of the same medication given by pill.

As with asthma medications, there are quite a number of nasal sprays to choose from:

• Over-the-counter saline sprays help thin the mucus and moisturize nasal membranes
• Over-the-counter decongestant sprays reduce the swelling in nasal passages (but don’t use them for more than a few days, or symptoms could get worse again – doctors call this “rebound”)
• Over-the-counter mast cell inhibitors (cromolyn sodium) reduce the irritation or allergic reaction causing the runny nose.
• Prescription antihistamine sprays block the effect of the chemical histamine responsible for many allergy symptoms
• Prescription corticosteroid sprays treat and prevent inflammation that leads to swelling and mucus.

Nosey Notes

Which medication you and your medical care provider choose depends on how severe your symptoms are; how often they appear and how long they last; and whether you have other respiratory conditions like asthma, COPD or sinus problems.

When allergy symptoms disrupt your life and over-the-counter medications just don’t cut it, it’s time to see an allergist to determine which allergens to avoid and get a written plan of action.

• Don’t just treat the symptoms. To identify the cause and eliminate or treat many of the triggers, ask an allergist (www.AllergyandAsthmaRelief.org ^[1])
• Pollen and some mold allergies are seasonal but others, such as dust mite and animal dander, can cause symptoms throughout the year.
• Start using your nasal sprays a week before your sneezing season and don’t stop until it’s over.
• Over-the-counter nasal decongestant sprays should never be used for longer than three days without first consulting your physician. The more you use, the less effective they become.
• If you use a daily inhaled corticosteroid for asthma or COPD (whether a metered-dose inhaler, dry powder inhaler or nebulizer) as well as a nasal spray corticosteroid, talk with your healthcare provider to make sure the combined doses are not causing a systemic effect.

HOW TO USE A NASAL SPRAY

• Read and follow the package insert instructions for patients before using the first time. Prime the spray as directed before the first use or if you haven’t used it in a while (see your directions for repriming details).
• Blow your nose gently before using the spray to allow medicine to get up into the passages.
• Gently insert the tip of the nasal spray ¼-1/2 inch into your nose (it’s designed not to go too far, don’t try to push it in) and point it away from the center of your nose, toward your ear. Too much medicine on your septum (the tissue separating the two nasal passages) can be damaging, which is why you point it away from the center of the nose. Try holding the spray with your left hand when applying to the right nostril, then switch for the other side.
• Lean forward slightly, hold one nostril closed and inhale gently and deeply through the other as you release the spray. Exhale through your mouth. Do not blow your nose after using the spray; just wipe away any liquid that drips.
• Wipe the spray tip clean after every use and replace the cap. If it becomes clogged, check your manufacturer’s instructions for cleaning, but do not use a pin or other instrument to enlarge the hole.
• Keep track of the doses used and replace your nasal spray after you have used the recommended number, even if you haven’t reached the expiration date. (Include priming sprays!) There may be liquid left in the container after all the doses have been used, but the medication mix is not likely to be accurate.

First published in Allergy & Asthma Today, Summer 2010 ^[2]

Medical editors: Robert Bahadori, MD, and William Berger, MD

Related posts:

1. News for Your Nose: Nasal Corticosteroids ^[3]
2. Your Nose: The Ultimate Air Cleaner ^[4]
3. It’s Not ALL in Your Head ^[5]