Treatment of congestion in upper respiratory diseases

Review

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Authors: Eli O Meltzer, Fernan Caballero, Leonard M Fromer, et al

Published Date February 2010 Volume 2010:3 Pages 69 - 91

DOI: http://dx.doi.org/10.2147/IJGM.S8184

Eli O Meltzer¹, Fernan Caballero², Leonard M Fromer³, John H Krouse⁴, Glenis Scadding⁵

¹Allergy and Asthma Medical Group and Research Center, San Diego, CA and Department of Pediatrics, University of California, San Diego, USA; ²Allergy and Clinical Immunology Service, Centro Medico-Docente La Trinidad, Caracas, Venezuela; ³David Geffen School of Medicine, University of California, Los Angeles, USA; ⁴Wayne State University School of Medicine, Detroit, Michigan, USA; ⁵Department of Allergy and Rhinology, Royal National TNE Hospital, London, UK

Abstract: Congestion, as a symptom of upper respiratory tract diseases including seasonal and perennial allergic rhinitis, acute and chronic rhinosinusitis, and nasal polyposis, is principally caused by mucosal inflammation. Though effective pharmacotherapy options exist, no agent is universally efficacious; therapeutic decisions must account for individual patient preferences. Oral H₁-antihistamines, though effective for the common symptoms of allergic rhinitis, have modest decongestant action, as do leukotriene receptor antagonists. Intranasal antihistamines appear to improve congestion better than oral forms. Topical decongestants reduce congestion associated with allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral decongestants show some efficacy against congestion in allergic rhinitis and the common cold, and can be combined with oral antihistamines. Intranasal corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with allergic rhinitis, and show some congestion relief in rhinosinusitis and nasal polyposis. Immunotherapy and surgery may be used in some cases refractory to pharmacotherapy. Steps in congestion management include (1) diagnosis of the cause(s), (2) patient education and monitoring, (3) avoidance of environmental triggers where possible, (4) pharmacotherapy, and (5) immunotherapy (for patients with allergic rhinitis) or surgery for patients whose condition is otherwise uncontrolled.

Keywords: allergic rhinitis, congestion, obstruction, rhinosinusitis, treatment

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