It’s that time of year, but while the temptation is to keep blowing your nose, it probably won’t help.
A blocked nose from a common cold is caused not by mucus, but by swelling and inflammation of the blood vessels in the nasal airways, triggered by the infection, explains Dr Ayah Al Ayoubi, consultant Ear, Nose and Throat (ENT) surgeon at Chase Farm Hospital, London.
Struggling with a blocked-up nose? It's that time of year, but while the temptation is to keep blowing your nose, it probably won't helpSo if you must blow your nose, it’s best to blow gently, one nostril at a time.
And don’t bother inhaling the steam from a bowl of recently boiled water because that won’t help unblock your nose either.
But what about an over-the-counter remedy?
Decongestants — in the form of tablets or medicated nasal sprays — contain different chemicals that work as vaso-constrictors.
These narrow the small blood vessels in the nose, so reducing blood flow, which brings down the swelling and helps to open up the nasal airway so you can breathe more easily.
However, such decongestants should be avoided by people with heart disease, high blood pressure, glaucoma or diabetes.
That’s because the vaso-constricting drugs also work as stimulants, raising the heart rate and blood pressure.
These problems are more common with oral tablets which provide a higher dose to the bloodstream than sprays because, if used properly, sprays should be limited to the vessels in your nose.
Yet despite this, sprays are actually four to five times more effective than tablets as they are applied right at the source of the congestion, says Professor Ron Eccles, director of the common cold centre at Cardiff University.
A spray is also unlikely to cause side-effects since the amount of medicine absorbed into the bloodstream from the nose is fairly limited.
Sometimes a spray can cause more sneezing and a dry mouth or throat; tablets can cause raised heart rate and dizziness in some people.
Because of their stimulant effect, these products may well disturb your sleep, says Nicholas Eynon-Lewis, a consultant ENT surgeon at the London Nose Clinic.
So if you do take an oral decongestant, it is better to do so during the day. This is not such a concern with the sprays.
Don’t use decongestants for more than a week, or you could end up with more severe congestion — rhinitis medicamentosa.
Normally, the spray shrinks the tissue. But overuse of the drug causes the tissue to swell rather than shrink, making a blocked nose even worse.
And as the tissue swells, the medication stops working.
Mr Eynon-Lewis adds that you should also limit use of sprays to no more than three times a day.
Any kind of spray will only be effective if used properly, says Henry Sharpe, a consultant ENT surgeon at East Kent Hospital.
‘They need to go into the nose, rather than ending up down your throat, if you want them to work.
'To do this, kneel on the floor with your head on the ground or lean over the edge of a table or chair so that your head is forward. Don’t use them sitting up.’
‘Once the drops are in your nose, stay in this position for a minute or two to let the drops work their way up to the top of the nose between the eyes.’
We asked Mr Eynon-Lewis for his verdict on the most useful over-the-counter remedies...
Otrivine Adult Nasal Decongestant Spray, £2.99
This, in turn, reduces blood flow, which brings down the swelling and helps to open up the nasal airway so you can breathe more easily.
The main disadvantage is that there is the risk of rebound congestion if you use a spray like this for more than seven days. 9/10
Olbas Inhalation Drops, £3.25
In fact you’re not, though the sense of relief is immediate.
The plus side is there is no risk of side-effects, and it’s worth using for the comforting sensation of feeling like you can breathe easier again.
However the drops are unlikely to give any relief once you stop inhaling.
Don’t use in hot, steaming water as this makes the vessels in the nose swell rather than shrink; use them with warm water instead. 5/10
Boots Max Strength Sinus Relief, £3.15 for 16 capsules
This last ingredient is related to adrenalin and its potential side-effects include anxiety, tremor and difficulty sleeping, particularly if combined with caffeine.
Generally, these side-effects are uncommon although make sure you do not take more than the recommended dose.
It’ll help clear congestion but what concerns me about tablets like this is you must be careful to take paracetamol content into account if you’re already taking tablets separately or you could overdose.
Some oral decongestants raise your resting heart rate, so that when you start to exercise your heart rate is higher than usual.
So if you take decongestant tablets, cut back to moderate exercise if you are unfit — or leave it until you feel better — as a raised heart rate could lead to myocardial ischemia, a condition which can damage the heart muscle.
Oral decongestants may also interact with some antidepressants and beta-blockers.
So if you are on any kind of medication, check with your GP or pharmacist before using these. 6/10
Sudafed Mucus Relief 0.1% Nasal Spray, £4.29
Decongestant sprays such as this work directly on the blood vessels in the nose, so take effect quickly, within ten minutes or so.
However, their effect only lasts for a few hours. It is better to use a spray in the evening as this will clear your nose so that you’re less likely to have disturbed sleep. 8/10
Breathe Right Nasal Strips, £5.99
They may help with snoring and breathing at night, although they won’t actually reduce the swelling and mucus in the nose, which is the cause of congestion. 3/10
Beconase Aqueous Nasal Spray, £5.49
Corticosteroids are hormones that are produced naturally by the adrenal glands and have many important functions, including controlling the inflammatory response and so reducing inflammation or swelling in the nose caused by increased blood flow to the nasal tissues.
This nasal steroid spray shouldn’t be used for a short bout of cold and flu as the swelling with these is caused by inflammation rather than increased blood flow. It is better for treating long-term nasal congestion. 2/10
Sinutab Non-Drowsy, £3.95 for 15
The decongestant used in this product is pseudoephedrine hydrochloride, which can act as a stimulant, so take in the morning rather than the evening. 7/10
Vicks Sinex Decongestant Capsules, £4.05 for 16
The only difference is that there is no caffeine — important if you don’t want to have caffeine in your diet as some people are sensitive to it.
7/10
. . . and the low-tech option
An alternative to using a medicated product is a saltwater remedy, says Mr Sharpe.‘It flushes the mucus out like a douche, while also having a thinning effect on it.’
This won’t reduce swelling of the nasal tissue but will provide temporary relief from a runny nose.
Mr Sharpe suggests making your own by mixing a teaspoon of salt with half a teaspoon of bicarbonate of soda and 8oz of warm (previously boiled) water.
There are saltwater products that you can buy, such as Sterimar Sea Water Nasal Spray Isotonic (£6.99 for 100ml), and as they are not medications, you can use them several times a day as there are no side-effects, adds Mr Eynon-Lewis.
‘However relief may be brief — less than medicated nasal sprays which can last for several hours.
‘Also, it’s important to note that what makes the remedy effective is volume rather than pressure, so washing out the nose with salt water is even better than using a saltwater spray — which is also more expensive than nasal sprays.’
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