Treatment of congestion in upper respiratory diseases
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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