Upper Respiratory Infections
The information below is provided in order to help you in treating upper respiratory infections, and in using some of the commonly purchased and commonly prescribed medications. Please read this during the current course of treatment, but also hold onto it and reference it if and when your next upper respiratory infection occurs.
Decongestant Nasal Sprays
Afrin®, or any over-the-counter decongestant nasal spray, is helpful as an initial step in treating upper respiratory infections. This spray can be used for up to approximately five days, and is used twice per day. Use of Afrin or any other topical nasal decongestant spray for longer than five days will result in a physical addiction, in which the nasal lining will become significantly swollen and irritated until the spray is used again.
Nasal saline is available over the counter or can be made at home. There are many different commercial preparations such as Ocean® spray and AYR® spray, as well as others. Nasal saline can be used in an unlimited fashion. If you have had sinus surgery, you will have received instructions on how to use this with a WaterPik® machine. Otherwise, you can purchase an over-the-counter preparation or make your own. (Directions for home-made saline spray.) Saline is used by “snorting” the mist up into the nose then later gently blowing the nose to get rid of any secretions that it has loosened.
Nasal steroid medications are useful for upper respiratory infections, allergies, and sensitivities to airborne irritants. Unfortunately, they do not begin to work for a day or two, and they do not reach their maximum benefit for approximately two to three weeks. Initial therapy is typically two puffs per nostril twice per day. This should be used for only a few days, then the maintenance dosage is one or two puffs per nostril once per day. This can be done at any time of the day. The most effective way to use any nasal medication is to look down at your toes when spraying it in. Aim slightly away from the septum (dividing plate between the nostrils), and gently inhale. This ensures that the spray will go into the sinus cavities and not straight up into the nose. A good way to avoid spraying onto the septum is to use the right hand to spray into the left nostril, and vice versa for the right nostril. Occasionally, nasal steroids can increase the risk of nosebleeds, but in general they are very well tolerated and effective medications.
Astelin® is a topical nasal antihistamine. Astelin is used in a manner similar to nasal steroids, but it is used twice a day. Astelin is very foul-tasting if it runs down the back of your throat, so be very careful to gently inhale when using Astelin. Also, gargling or spitting out any spray that does make it down your throat will help with this taste. Astelin can sedate some people, so if it does it may be better to use it just at night.
Antihistamines are available both over-the-counter and as a prescription. There are also various decongestant and antihistamine combinations available. The three main prescription choices are Clarinex® (and Claritin®), Allegra®, and Zyrtec®. In general, take any antihistamine-decongestant combination in the morning to avoid insomnia. Zyrtec should probably be taken at night, in order to reduce the chance of sleepiness during the daytime. If there is a significant infection present and secretions are already thickened, antihistamines are often discontinued in favor of a mucous thinner/decongestant combination.
Mucous Thinners and Decongestants
Mucous thinners and decongestants are used to shrink down the tissues and promote sinus drainage. There are multiple prescription and over-the-counter varieties available. A mucous thinner will tend to be drying unless you are also drinking plenty of water when taking these. If you have high blood pressure, it is very important to monitor your pressure while on decongestants. The mucous thinner/decongestant combinations are typically given twice per day. However, some people will be unable to tolerate these at night and should only take them once per day.
In particularly severe infections, oral steroids can be used. Often, they are the only medications that will reduce the symptoms of pressure and allow the nasal sinuses to drain. These are best taken on a full stomach and earlier in the day is better. They may give you some irritability, stomach upset, or hyperactivity. This can also interfere with sleep. A person who has high blood pressure or diabetes needs to be very careful to monitor their pressure or blood glucose while taking steroids. Steroids can have multiple side effects when taken long-term, but short-term doses are very well tolerated and extremely effective in controlling the symptoms associated with acute and chronic sinus infections, severe allergies, or nasal polyps. The only significant side effect of note with oral steroids is the extraordinarily uncommon occurrence of damage to the hip cartilage, which is very rare in and of itself, and is usually associated with long-term usage of steroids. The use of steroids for greater than approximately seven days requires a tapering down in order to discontinue them. Thus, you should not abruptly stop your steroid if you have been taking the same dose for greater than one week.
Finally, when all of these other measures have failed and a bacterial infection is present, an antibiotic will be prescribed. The most common symptoms of acute sinusitis of a bacterial nature are pain, pressure, and thick and colored nasal drainage. However, not all colored drainage means that there is a bacterial infection present. According to the Center for Disease Control, only two percent of colds will progress to result in bacterial sinusitis. Thus, most upper respiratory infections should NOT be treated with antibiotics. Antibiotics should be reserved for upper respiratory infections which last longer than ten days, or which worsen after four or five days of treatment. The use of antibiotics for nonbacterial upper respiratory infections has resulted in a severe problem with the emergence of bacteria which are resistant to multiple forms of antibiotics, and some bacteria are currently only treatable with intravenous antibiotics.