Treatment of congestion in upper respiratory diseases

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.

A Single-centre, Before-After Study of the Short- and Long-term Efficacy of Narivent® in the Treatment of Nasal Congestion

“…1 Intranasal corticosteroids have potent and broad anti-inflammatory activities. In controlled clinical trials, they have been shown to be more effective than other classes of agents for the relief of congestion.…”

“…They do not, however, reduce mean nasal congestion V Damiani, A Camaioni, C Viti et al Narivent ® for nasal congestion scores to normal levels or effectively reduce congestion in every patient. 1 Decongestants are sympathomimetic drugs, employed as systemic or topical products, which act by constricting capacitance vessels in the turbinates to produce a decrease in subjective symptoms and nasal airway resistance. 6,26 Frequently reported decongestant side effects in patients with chronic nasal congestion include systemic effects such as elevated blood pressure, tachycardia, palpitations, restlessness, insomnia, anxiety, tremors and hypersensitivity reactions; side effects of topical agents include burning, stinging, sneezing and local irritation.…”

“…17,18 Although various pharmacological options exist, no agent has been proven to be completely efficacious, and there is a paucity of data supporting commonly used symptomatic therapies. 1 Narivent ® (DMG Italia Srl, Pomezia, Italy) is a medical device dispensing a nasal lubricant containing eucalyptol, glycyrrhizin and mannitol that acts osmotically and has antioedematous and anti-inflammatory actions. 19,20 The present study was conducted in order to evaluate the short-(7 days) and longerterm (30 days) safety and clinical effectiveness of Narivent ® on subjective and objective symptoms in patients with persistent nasal congestion.…”

Efficacy and Safety of a Combination of Paracetamol, Levocetirizine and Phenylephrine in the symptomatic treatment of Common Cold and Allergic Rhinitis in Children: Phase IV Clinical Study

“…It has abridged anticholinergic and antiserotonin effects and therefore is singled out in patients with allergy since it does not over dry respiratory secretions 9 .Phenylephrine is a sympathomimetic primarily used as a systemic nasal decongestant 6 . The mechanism by which decongestants bring off their action is by activation of postjunctional alpha 1-adrenergic receptors found on precapillary and post capillary blood vessels of the nasal mucosa.…”

A Before-after Assessment of the Efficacy of Narivent® in the Treatment of Symptoms Associated with Allergic Rhinitis in a Paediatric Population

“…Nasal congestion is therefore a prominent manifestation of allergic rhinitis and is often the symptom patients find most troublesome and would like most to prevent [9,10]. Furthermore, typical sleep-related problems seen in AR, such as sleep-disordered breathing, sleep apnea, and snoring, are associated with nasal obstruction [11].…”