Download rhinitis

Pharmaceutical
guidelines of patients
with pathology of
breathing organs.
Symptomatic
treatment of
RHINITIS
Rhinitis
inflammation of the mucous lining of
the nose
• Rhinitis is a nonspecific term that
covers infections, allergies, and
other disorders whose common
feature is the location of their
symptoms. In rhinitis, the
mucous membranes become
infected or irritated, producing a
discharge, congestion, and
swelling of the tissues. The most
widespread form of infectious
rhinitis, is the common cold.
Related symptomatic terms
• Rhinorrhea (secretions discharged
from the nose)
• Nasal congestion is manifested by
obstructed nasal passages (“stuffy
nose”) and nasal drainage (“runny
nose”).
Persistent rhinitis
• This means that rhinitis symptoms continue
long-term (symptoms that last for an hour
or more on most days of the year). In many
cases the symptoms are present for some
part of the day on most days. In some cases
the symptoms come and go.
The severity can vary. Some people have
mild nose irritation which comes and goes,
and causes little trouble. On the other hand,
some people become distressed by their
regular, daily symptoms. Severe symptoms
can affect work, school, home and social
life.
Persistent allergic rhinitis
• The most common cause of persistent
rhinitis is an allergy to the house dust mite,
allergy to pets or other animals
• Hay fever (caused by an allergy to pollen) is
another type of allergic rhinitis. Hay fever
tends to be seasonal and not persistent
because it occurs during a particular period
each year (the grass pollen season during
late spring and early summer)
• Symptoms of allergy in the nose are due to
the immune system reacting to the allergen.
Cells in the lining of the nose release
histamine and other chemicals when they
come into contact with the allergen. This
causes inflammation in the nose (rhinitis)
and the typical symptoms.
Persistent non-allergic
rhinitis
Triggers for persistent rhinitis (can cause a
rhinitis in their own right, but they can also
make symptoms worse if a person already
have an allergic rhinitis)
• Irritation of the nose by smoke, strong
smells, fumes, chemicals, changes in
temperature or humidity.
• Hormonal changes during pregnancy and
puberty, which can sometimes cause nose
symptoms.
• If a person has an overactive thyroid gland,
this can also sometimes lead to rhinitis.
• Food and drink - mainly hot, spicy food, or
alcohol. Sensitivity to certain food
colourings or preservatives may be a cause.
• Emotion such as stress or sexual arousal can
sometimes affect the nose.
Persistent non-allergic
rhinitis
• Medication - a side-effect from certain
medicines is a rare cause. These include:
betablocker medicines, aspirin and other
anti-inflammatory medicines, angiotensin
converting enzyme (ACE) inhibitors, the
contraceptive pill and chlorpromazine.
• Rhinitis medicamentosa - rhinitis that can
occur due to the overuse of nasal
decongestant sprays. These sprays are used
to help a blocked nose and they reduce
swelling of blood vessels in the nose. If they
are used for more than 5-7 days, the
swelling can recur again. The temptation is
to use yet more decongestant and a vicious
circle can be set up. A similar problem can
occur in people who abuse cocaine.
Persistent non-allergic
rhinitis
• In some people, no specific trigger
for their persistent rhinitis may be
found. This is called idiopathic
rhinitis.
Persistent rhinitis
• Persistent rhinitis is common. It can affect
anyone of any age although it affects adults more
commonly than children. It is becoming
increasingly common in older people. Colds are
due to viral infections, and normally only last a
week or so. Persistent rhinitis is not due to an
infection.
-Allergic rhinitis (be it hay fever or persistent
rhinitis) tends to run in families. A person is also
more likely to develop allergic rhinitis if he
already has asthma or eczema. Equally, if a
person has allergic rhinitis, he is more likely to
develop eczema or asthma. The conditions
asthma, eczema and allergic rhinitis are known
together as atopic conditions or atopy. A
tendency to atopy can run in families.
Causes
• Comon cold
• Allergic rhinitis
May be treated
with OTC agents
• Nasal polyps
• Foreign bodies in
nasal passage
• Sinusitis
Consultation of a
doctor is needed
The common cold
• The common cold is the most
frequent viral infection in the general
population, are self-limited, lasting
about 3-10 days, although they are
sometimes followed by a bacterial
infection. Children are more
susceptible than adults; teenage
boys more susceptible than teenage
girls; and adult women more
susceptible than adult men.
TREATNING SYMPTOMS
• Rhinitis accompanied by
hyperthermia above 38-38,5 °C
• An unpleasent smell from a nose
• Hemorrhagic nasal discharge
• Purulent nasal discharge
• Rhinitis accompanied by cough
(longer then a week)
• Rhinitis accompanied by long
steading (weeks) hyperthermia
Nasal decongestants are used to relieve
nasal obstruction and
discharge
• Adrenergic (sympathomimetic) drugs
are most often used for this purpose:
relieve nasal congestion and swelling
by constricting arterioles and
reducing blood flow to nasal mucosa.
Oxymetazoline is a
commonly used nasal
spray;
pseudoephedrine is
taken orally. Rebound
nasal swelling can
occur with excessive
or extended use of
nasal sprays (eg, >7
days, perhaps
sooner).
Sympathomimetic
alpha-sympathomimetics (naphazoline,
tetrahydrozoline,xylometazoline)
• Initially, vasoconstriction reduces mucosal blood
flow and, hence, capillary pressure. Fluid exuded
into the interstitial space is drained through the
veins, thus shrinking the nasal mucosa.
• Due to the reduced supply of fluid, secretion of
nasal mucus decreases. In coryza, nasal patency
is restored.
• After vasoconstriction subsides, reactive
hyperemia causes renewed exudation of plasma
fluid into the interstitial space, the nose is
“stuffy” again, and the patient feels a need to
reapply decongestant. In this way, a vicious cycle
threatens. Besides rebound congestion,
persistent use of a decongestant entails the
risk of atrophic damage caused by
prolonged hypoxia of the nasal mucosa
Menthol Ointment
Days of wiping and blowing the nose can
leave the skin around nostrils sore and
irritated. A simple remedy is to dab a
menthol-infused ointment under, but not
in, the nose. Menthol has mild numbing
agents that can relieve the pain of raw
skin. As an added benefit, breathing in the
medicated vapors that contain menthol or
camphor may help open clogged passages
and relieve symptoms of congestion. Use
only in children over 2 years of age.
Nasal Strips
• Another strategy for
relieving nighttime
congestion is to try
over-the-counter
nasal strips. These are
strips of tape worn on
the bridge of the nose
to open the nasal
passages. While they
can't unclog the nose,
they do create more
space for airflow.
Allergic rhinitis treatment
• avoiding the cause of the allergy(if a
person can avoid the cause of an
allergy, symptoms should reduce and
stop - this is not as easy as it
sounds),
• antihistamine nose sprays,
• antihistamine tablets,
• steroid nose sprays.
Antihistamines
• Antihistamines relieve allergy symptoms
by blocking histamine, the chemical
“culprit” that causes many symptoms.
Antihistamines are classified as H1
blockers and H2 blockers, depending on
the type of receptors (on the surface of
cells) that they act on. H1 receptors are
associated with human tissue involving
capillaries, and H2 receptors predominate
in the lining of the stomach.
Antihistamine nasal sprays
• A dose from an antihistamine nasal
spray can rapidly ease itching,
sneezing and watering (within 15
minutes or so). It may not be so
good at easing congestion. A spray
can be used as required if a patient
have mild symptoms. It can also be
taken regularly to keep symptoms
away.
Antihistamine tablets (or
liquid medicines)
• Antihistamines taken by mouth (tablets or
liquids) are an alternative. They ease most
of the symptoms but may not be so good
at relieving nasal congestion (blocked
nose). Antihistamines taken by mouth are
good if the patient has eye symptoms as
well as nose symptoms. They are also
usually given to small children instead of a
nasal spray. A dose usually works within
an hour. Therefore, one can be taken as
required if symptoms are mild, or come
and go. One can also be taken regularly if
symptoms occur each day.
Antihistamines
First generation antihistamines
• Benadryl (diphenhydramine)
• Chlor-Trimeton
(chlorpheniramine)
Antihistamines
• First generation antihistamines have drawbacks
that include being short-acting, making it difficult
to concentrate, and drowsiness. The major side
effect of this allergy medication is drowsiness.
Histamine is actually a neurotransmitter which
helps nerve cells communicate, thus allowing
brains to work properly. An “antihistamine,”
therefore, would block the normal way brains
function.
• The drug manufacturers warn patients who take
this medicine to avoid activities in which they
need to remain alert, such as: driving, operating
machinery, and performing physically dangerous
tasks. People who can not avoid these activities
are advised to take this medication only at night.
Antihistamines
1st generation
• other side effects include: increased
anxiety, nausea, loss of libido,
depression, fatigue, loss of appetite,
difficulty with urination, tremors, dry
mouth, gastritis, and dizziness.
2nd
•
•
•
•
Antihistamines
generation antihistamines
zyrtec (cetirizine)
allegra (fexofenadine)
clarinex (desloratadine)
claritin (loratadine)
• They are less likely to cause the drowsiness
associated with the older medications, so they
are often referred to as “nonsedating.” Although
claritin has been recently made available overthe-counter, most of the nonsedating
antihistamines require a prescription. In general,
if these newer antihistamines do not work well
for a patient, doctors will then resort to the
original, first generation antihistamines.
3rd
Antihistamines
generation antihistamines
• First generation antihistamines can potentially
cause problems because of their tendency to
cause sedation. Second generation antihistamines
such as loratadine and cetirizine were developed
in the early 1980s, and they provided a distinct
benefit in that they did not cause the side-effect
of sedation for patients. A problem developed,
however, when some of these newer drugs were
found to cause cardiac problems.
• Third generation antihistamines may soon be the
best antihistamines for many patients. They are
now being developed in order to eliminate the
possibility of cardiac toxicity. One of the first of
these, fexofenadine, was approved in July of
1996, and more third generation antihistamines
are under development.
Steroid nasal sprays and
drops
• A steroid nasal spray usually works well to clear
all the nasal symptoms (itch, sneezing, watering
and congestion). It works by reducing
inflammation in the nose. A steroid nasal spray
also tends to ease eye symptoms. It is not clear
how it helps the eye symptoms - but it often does!
Steroid nasal drops are also sometimes used.
It takes several days for a steroid spray to build
up to its full effect. In some people it can take up
to three weeks or longer to be fully effective. A
steroid nasal spray tends to be the most effective
treatment when symptoms are more severe. It
can also be used in addition to antihistamines if
symptoms are not fully controlled by either alone.
Steroid nasal sprays and
drops
• It is needed to use the spray each
day to keep symptoms away.
However, once symptoms have gone,
the dose of a steroid spray can often
be reduced to a low maintenance
dose each day to keep symptoms
away. Side-effects or problems with
steroid nasal sprays are rare
Other nasal sprays
• They tend to be used if there are problems
with any of the above treatments.
Sometimes one is used as an add-on
treatment in addition to one or more of
the above treatments if symptoms are not
fully controlled:
 Sodium cromoglicate nasal spray. Like
steroid sprays, it takes a while to build up
its effect, and needs to be taken regularly.
One disadvantage is that it needs to be
taken 4-5 times a day (steroid sprays are
taken 1-2 times a day).
Other nasal sprays
• Ipratropium bromide nasal spray may be worth a
try if one have a lot of watery discharge. It has
no effect on sneezing or congestion.
• Decongestant nasal sprays are not usually
advised for more than a few days. They have an
immediate effect to clear a blocked nose.
However, if a person uses one for more than 5-7
days, a rebound, more severe congestion of the
nose often develops. One may be useful for a few
days to clear a blocked nose when the patient
first uses a steroid nasal spray. The steroid can
then get to the lining of the nose to work. Don't
use decongestant nasal sprays for more than
seven days. You should also not use a
decongestant nasal spray if you are taking an
antidepressant called a monoamine oxidase
inhibitor (MAOI).
EYE DROPS
in addition to other treatments:
• Antihistamine eye drops work quickly,
using as required to ease a flare-up of eye
symptoms or regularly if needed.
• 'Mast cell stabilisers' are another type of
eye drop. They are thought to work by
stopping the release of histamine from
mast cells. It is needed to use them
regularly to prevent symptoms.
Treatment for severe
symptoms
• Rarely, a short course of steroid
tablets is prescribed (for students
sitting exams, who have severe
symptoms which are not eased by
other treatments). Steroids usually
work well to reduce inflammation. A
short course is usually safe.
Duration of treatment
• Persistent rhinitis is an ongoing (chronic)
condition that usually needs regular
treatment to prevent symptoms. However,
over time the condition may ease, and
even go completely in some cases. It may
be worth stopping treatment every six
months or so to see if symptoms come
back without the treatment. The
treatment can be started again if
symptoms return
Pharmaceutical guidelines
RHINITIS
• All decongestants are not recommended
to apply more than 2 weeks
• Preparations, containing a
pseudoephedrine and phenilpropanolamin,
can cause sense of anxiety, insomnia,
tremor, there is a risk of development of
stroke at their application, violations of
cerebral circulation of blood (even for
young people) and cardiac arrhythmias,
delay of urination for patients with the
hypertrophy of the prostate gland
(pseudoephedrine)
Pharmaceutical guidelines
RHINITIS
• Preparations, containing a
pseudoephedrine and
phenylpropanolamin, are not combined
with an alcohol, are contraindicated the
drivers of motor transport
• Sympathomymetics can cause the
increase of blood pressure, therefore it is
necessary to appoint them patients with
arterial hypertension and hyperthyroidism
with a carefulness
Pharmaceutical guidelines
RHINITIS
• Sympathomymetics can cause the
increase of ophthalmotonus, therefore it is
necessary to appoint them patients with
glaucoma with a carefulness
• Drugs, containing sympathomymetics, can
strengthen an action and side effects of
antidepressants, monoaminooxidase
inhibitors, psychostimulators (increasing
of arterial pressure).
Pharmaceutical guidelines
RHINITIS
• Preparations, containing
sympathomymetics, can weaken the
action of antihypertensives and betablockers, that shows up in the
increase of pressure and, at
combined application with betablockers, possibilities of development
of heart arrhythmias