Nasal Congestion Nasal Congestion Is the Fourth Most Common Minor Ailment Presenting in Primary Care, with 5.3 Million Consultations Per Year

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32 • Self care 9 November 2012 Self care for minor ailments Nasal congestion Nasal congestion is the fourth most common minor ailment presenting in primary care, with 5.3 million consultations per year. At a cost of £17.4 million per annum, it is a symptom that can be easily managed through self care

WHAT IS NASAL CONGESTION? WHAT CAN PATIENTS EXPECT? TOP 10 MINOR AILMENTS Nasal congestion occurs when blood Patients with a cold can expect SEEN IN GENERAL PRACTICE vessels in the nasal mucosa are symptoms to develop over one to two inflamed. This results in a blocked or days and improve within a few days, 1. Back pain congested nose and difficulty breathing. although symptoms can persist for up to 2. Dermatitis The primary underlying causes are two weeks. Flu symptoms have a more 3. Heartburn and indigestion rhinitis, such as allergic rhinitis e.g. rapid onset than cold symptoms. 4. Nasal congestion hayfever, the common cold and flu (or Recovery time is around a week, 5. Constipation flu-like illness), and nasal polyps. although fatigue can last longer. 6. Migraine Depending on the causative Rhinitis sufferers can expect to suffer 7. Cough condition, sufferers may also experience from nasal congestion for as long as 8. Acne accompanying symptoms: their triggering allergen is present; this 9. Sprains and strains Rhinitis – while nasal congestion is the can be year-round for those allergic to 10. Headache • most common and bothersome dust mites or cat/dog dander, for feature of allergic rhinitis, rhinorrhoea example, and for several months during (runny nose), itchy nose, sneezing, spring/summer in those with hayfever or itchy and watering eyes also occur. allergies to moulds or spores. Rhinitis Sleep can also be impaired also increases the risk of an Common cold/flu – nasal congestion exacerbation of asthma. • is the most frequent symptom, with rhinorrhoea, sore throat, cough, fever, WHAT CAN PEOPLE DO TO HELP sneezing, muscle aches, headache, THEMSELVES? fatigue and post-nasal drip potentially For those with colds and flu, the key present. advice is to stop the transmission of the virus by advising sufferers to: HOW COMMON IS IT? Catch it – catch coughs and sneezes Allergic rhinitis alone affects up to 25% • into tissues of the population. Common colds affect Bin it – throw tissues away adults on average two to four times per • immediately year, with children suffering up to six Kill it – wash hands and clean surfaces episodes. • regularly to keep them free from germs.

TABLE 1 RED FLAG SYMPTOMS

Dr Knut Schroeder FRCGP Cold and flu Rhinitis GP, Concord Medical Centre, Bristol, and Honorary Senior Clinical Lecturer in Primary Stridor Bloody purulent discharge Health Care, University of Bristol Drooling Pain and nasal blockage, often only on one side Self Care Forum Board member and author of ‘Diagnosing Your Health Symptoms For Difficulty swallowing Nasal pain Dummies’ Difficulty breathing Nosebleeds Sara Richards RN Severe headache Crusting Specialist Primary Care Nurse, Practice Nurse Facilitator, Berkshire Nasal deformity due to a perforated septum Self Care Forum Board member Self care • 33

Oral decongestants and antihistamines are often combined with analgesics to relieve fever, aches and pains, and congestion. The MHRA advises that combination cough and cold medicines should not be used in children under 6 years of age.

WHEN SHOULD PATIENTS RETURN? Patients should seek medical advice if their symptoms do not respond to treatment, worsen or if they develop red flag symptoms and signs. Unless rhinitis patients have red flag symptoms (see Table 1), they can be advised to continue with their self care choices.

WHAT ARE THE NEXT STEPS? Cold and flu are self-limiting conditions and generally do not require further interventions, unless there are significant complications such as sinusitis and otitis media. For rhinitis, hyposensitisation can be considered for severe symptoms of Nasal congestion certain allergies, such as pollen. is the most frequent Symptoms and signs that may suggest symptom of the a more serious underlying problem are common cold shown in Table 1.

SUMMARY Also advise resting, eating well and seven days in adults (five days in 6-12 Nasal congestion is a troublesome keeping hydrated. For those with fever, year olds), as prolonged use can cause problem in primary care. OTC treatments extra fluid intake is recommended to rebound congestion. can provide effective relief and this avoid dehydration. Patients with nasal congestion due to should be supplemented in rhinitis Rhinitis sufferers should be advised to rhinitis can also be recommended sufferers with advice on avoiding triggers. take measures to avoid their triggers, e.g. intranasal corticosteroids and/or The presence of red flags should prompt for house dust mites clean soft furnishings antihistamines. Common intranasal further medical assessment. and upholstery regularly, and for allergic corticosteroids include beclometasone, • rhinitis keep doors and windows closed fluticasone and triamcinolone, and RESOURCES during peak pollen periods (mid-morning provide superior relief of nasal and early evening). congestion symptoms in those aged 18 Taverner D, Latte GJ. Nasal years and over. The full effects can take decongestants for the common cold. WHICH OTC PREPARATIONS CAN several days to develop, therefore Cochrane Database of Systematic PEOPLE USE? antihistamines can be used in the Reviews 2007, Issue 1. Art. No.: Oral decongestants, such as interim for relief. These are also a good CD001953. DOI: 10.1002/14651858. CD001953.pub3. pseudeoephedrine or phenylephrine, option for patients who prefer oral work by constricting the nasal blood treatment or who are younger than 18. British Society for Allergy and Clinical Immunology. www.bsaci.org vessels and can be used by adults and Older antihistamines, such as children over 6 years (depending on the chlorphenamine (for use from 1 year The RCGP’s online learning module Self product). Topical decongestants, in the onwards) or promethazine (from 2 Care for Minor Ailments is available for all healthcare professionals at http:// form of drops or sprays, contain years, depending on product), can elearning.rcgp.org.uk/course/info. ephedrine, oxymetazoline or cause drowsiness, unlike newer php?id=80. xylometazoline. While they can be used antihistamines, e.g. acrivastine (from 12 For more information on self care visit the in adults and children from the age of 6 years), cetirizine (from 2 years, Self Care Forum on www.selfcareforum. years (12 years for ephedrine), their use depending on product) and loratadine org and NHS Choices at www.nhs.uk. should be restricted to a maximum of (from 2 years).