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.

Keywords:

• allergic rhinitis
• congestion
• obstruction
• rhinosinusitis
• treatment

Acknowledgements

Editorial assistance was provided by Henry Hamilton, PhD, former employee of Health Science Communications, Inc., and Joyce O’Connor, MS of Health Science Communications, Inc. This assistance was funded by Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA.

Disclosures

Dr Meltzer: grant/research support from Alcon, Amgen, Apotex, AstraZeneca, Boehringer Ingelheim, Capnia, Genentech, GlaxoSmithKline, MAP Pharmaceuticals, Meda, Merck, Novartis, Pharmaxis, sanofi-aventis, Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA, Sepracor, Skye Pharma, Teva, Vocel, Wyeth; has been a consultant/speaker for Abbott, Alcon, Amgen, AstraZeneca, Capnia, Dey, Evolutec, Genentech, GlaxoSmithKline, Greer, Inspire, Johnson and Johnson, MAP Pharmaceuticals, Meda, Merck, Novartis, Pfizer, sanofi-aventis, Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA, Sepracor, Shionogi, VentiRx, Wyeth.

Dr Caballero: clinical research for GlaxoSmithKline, Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA, MSD and has received honoraria from them for lectures.

Dr Fromer: none.

Dr Krouse: consultant to Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA and Alcon Labs.

Dr Scadding: consultant/advisory board member for ALK, Britannia Pharmaceuticals, CMP Therapeutics, Groupo Uriach, GSK, Merck, sanofi-aventis, Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA, UCB; has received research funds from ALK, GSK, UCB, Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA; has given talks for ALK, GSK, Merck, Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA, UCB and has co-written articles for Schering-Plough Corporation, now Merck & Co., Whitehouse Station, NJ, USA and GSK.