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Nasal Congestion, How to Treat and Avoid Rebound Congestion

Nasal congestion can occur for many different reasons such as allergies, infections or the common cold. It is a condition that affects approximately 30-60 million Americans annually. There are a number of treatment options available, including both over-the-counter and prescription drugs. Nasal decongestants, or nasal sprays such as Afrin, can cause a condition known as rebound congestion.

Nasal congestion is caused by inflammation of the tissue and blood vessels in the nose. Nasal decongestants, such as Afrin (oxymetazoline) and Neo-Synephrine (phenylephrine), are used to treat this condition because they constrict the nasal blood vessels, thus relieving the congestion. But using these products for longer than recommended can lead to rebound congestion, which is an intense nasal stuffiness that occurs after the decongestant nasal sprays are stopped. While the exact reason behind rebound congestion is unknown, the main theory is that extended use of drugs that constrict blood vessels reduces blood flow to nasal tissue and causes some of the tissue to die. This causes the dead tissue to slough off inside nasal passages thus increasing congestion. This in turn results in a painful cycle of congestion as symptoms worsen when the decongestant is stopped.

To avoid rebound congestion nasal decongestants should only be used for short-term nasal congestion. Rebound congestion can occur with as little as three days of use, but the risk greatly increases after 10 days of use. For chronic nasal congestion nasal corticosteroids, antihistamines or oral decongestants should be used. Common nasal corticosteroids include Rhinocort (budesonide) and Flonase (fluticasone), which are both prescription products. Over-the-counter antihistamines include Benadryl (diphenhydramine) and Claritin (loratadine). Sudafed (psuedoephedrine) is a common over-the-counter oral decongestant.

Non-pharmacologic options for treatment include drinking lots of fluids such as water and fruit juice. Coffee should be avoided because it may cause dehydration, worsening congestion. A humidifier or steamy shower may ease the congestion by increasing the moisture in the air. Another treatment option is nasal passage irrigation, with products such as Neti Pots, that use saline and gravity to manually clear congestion from the nose.

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