Maximizing the efficacy of intranasal inhalers in allergic rhinitis and rhinosinusitis
|Raghuvir B. Gelot M.D. F.A.C.S.
Vidant Roanoke Chowan Hospital
202 NC Hwy 42 West
Ahoskie, N.C. 27910
Allergic rhinitis is an inflammatory disease of lining inside the nose. In addition to oral medicines such as antihistamines, decongestants and leukotriene blockers, it is also commonly treated with intranasal medicines in inhaler form such as Cromolyn to stabilize mast cells which release histamines and other chemicals, anticholinergic Ipratropium to control runny nose, antihistamines (Azalastine and Otopatadine) to relieve nasal congestion, post nasal drainage and sneezing, Corticosteroids to combat inflammation of late phase reaction of nasal mucosa and combination of antihistamine and steroid in one as step-up therapy for control of both early and late phase reaction.
To maximize the efficacy of these medications, I recommend use of nasal saline irrigation preceding the use of medication inhalers. There are beneficial effects of doing so. Saline rinse moisturizes nasal and sinus mucosa, improves the muco-ciliary cell function of mucous lining, removes inhaled particulate matters (pollens and irritants) and allows the medicines to reach the target without mechanical barriers such as mucus and debris.
This can be achieved by use of water pick with irrigation tip, cordless pulsating Sinugator, NasaFlo neti pot, sinus rinse squeeze bottle or 30 ml medicine syringe. Sterilize syringe and frequently and replace every 2 weeks to avoid contamination and infection. Do not use baby bulb syringe.