Acute rhinitis (acute runny nose) - Treatment and prevention

Treatment goals for acute rhinitis

Treatment of acute rhinitis is aimed at relieving the distressing symptoms of acute rhinitis and reducing the duration of the disease.

Indications for hospitalization

Acute rhinitis is usually treated on an outpatient basis. In rare cases of severe rhinitis accompanied by a significant increase in body temperature, bed rest is recommended. It is better to allocate a room with warm and humidified air for the patient, which reduces the painful feeling of dryness, tension and burning in the nose. You should not eat spicy, irritating food. It is necessary to monitor the timeliness of physiological functions (stool, urination). During the period of closure of the nasal passages, you should not forcibly breathe through the nose, you should blow your nose without much effort and at a time only through one half of the nose, so as not to throw pathological discharge through the auditory tubes into the middle ear.

Non-drug treatment of acute rhinitis

The abortive course of acute catarrhal rhinitis can be facilitated in the first days by using thermal, distracting and diaphoretic procedures. A hot general or foot (hand, lumbar) bath is prescribed, immediately after which the patient drinks hot tea, after which he takes 0.5-1.0 g of acetylsalicylic acid dissolved in water or 1.0 g of paracetamol orally. Then the patient should lie down in a warm bed, wrapped in a blanket. In order to influence the neuroreflex reactions in the nasal area, ultraviolet irradiation of the soles of the feet (in erythemal doses), mustard plasters on the calf areas, ultraviolet irradiation, UHF or diathermy on the nose, etc. are also used. All these means are more effective in the 1st stage of acute catarrhal rhinitis, but their beneficial effect can be useful in the 2nd stage as well.

Drug treatment of acute rhinitis

Drug treatment has certain differences in children and adults. In infants, from the first day of acute nasopharyngitis, the most important task is to restore nasal breathing during breastfeeding, which not only ensures normal nutrition, but also prevents the spread of inflammation to the auditory tubes and middle ear, as well as the lower respiratory tract. For this purpose, before each feeding, it is necessary to suck out mucus from each half of the child's nose with a balloon. If there are crusts in the vestibule of the nose, they are carefully softened with sweet almond oil or olive oil and removed with a cotton ball. 5 minutes before feeding, 2 drops of a vasoconstrictor are poured into both halves of the nose: 0.01-0.02% epinephrine solution and 2 drops of 1% boric acid solution (can be together). Between feedings, 4 drops of 1% collargol or silver proteinate solution are poured into each half of the nose 4 times a day. This substance, enveloping the mucous membrane of the nose and part of the pharynx, has an astringent and antimicrobial effect, which reduces the amount of discharge and has a beneficial effect on the course of the disease. A 20% solution of albucid can also be used. A 1% solution of ephedrine and other drugs with identical action have a good vasoconstrictor effect,

In adults, the main goal of treatment at stage 1 of rhinitis is considered to be the prevention of viral invasion and its replication in the epithelial cells of the nasal mucosa. This can be achieved by activating non-specific factors of local protection (mucociliary transport, secretory antibodies, immunocompetent cells, etc.) and the use of antiviral drugs.

Antiviral drugs:

• natural interferons (human leukocyte interferon);
• recombicant interferons (interferon alpha-2, etc.);
• interferon inducers [tilorone (orally), meglumine acridonacetate (gel on the nasal mucosa)]:
• antiviral immunoglobulins;
• Oxolin is a virucidal drug that destroys extracellular forms of herpes viruses and rhinoviruses and is used as a prophylactic agent;
• rimantadine is active against influenza A viruses;
• acyclovir selectively affects herpes viruses:
• aminocaproic acid binds to receptors of target cells, disrupts the interaction of the body and the virus. It is used for irrigation of the mucous membrane of the nose and throat,

However, the main treatment for rhinitis at this stage, as well as at other stages, is considered to be vasoconstrictors. A wide variety of vasoconstrictors are used to relieve nasal congestion. For sinusitis, preference is given to local nasal vasoconstrictors. This group of drugs includes:

• alpha1-andrenergic receptor agonists (phenylephrine);
• alpha2-adrenergic receptor agonists (xylometazoline, naphazoline, oxymetazoline);
• alpha, beta-adrenergic receptor agonists (epinephrine);
• drugs that promote the release of norepinephrine (ephedrine);
• agents that prevent the utilization of norepinephrine (cocaine).

Phenylephrine, having a mild vasoconstrictor effect, does not cause a significant decrease in blood flow in the nasal mucosa, therefore its therapeutic effect is less pronounced and shorter-lasting. Oxymetazolium derivatives have a more pronounced therapeutic effect compared to other vasoconstrictors. The longer effect of alpha2-adrenoreceptor agonists is explained by their slow removal from the nasal cavity due to a decrease in blood flow in the mucous membrane. At the same time, drugs produced in the form of nasal sprays are more convenient for practical use, which allow you to reduce the total dose of the administered drug due to its more uniform distribution on the surface of the mucous membrane. Epinephrine and cocaine are practically not used in everyday medical practice.

Infusions of medicinal preparations are made 3 times a day, 5 drops in each half of the nose or in one half (in case of a unilateral process). Before infusion and 5 minutes after using the drops, it is recommended to blow your nose well. It is better to instill drops in a lying position with the head thrown back. This position ensures better penetration of the drug to the anastomoses of the paranasal sinuses, their opening and, therefore, more effective drainage of the contents. Short-term courses of treatment with local vasoconstrictors do not lead to functional and morphological changes in the nasal mucosa. Long-term (over 10 days) use of these agents can cause the development of nasal hyperreactivity, changes in the histological structure of the mucous membrane, that is, cause the development of drug-induced rhinitis. If necessary, it is better to replace vasoconstrictor drops with astringents (3% solution of collargol or silver proteinate, which are used in the same way as drops).

It is permissible to use systemic vasoconstrictors (phenylephrine, phenylprolanolamine, ephedrine, pseudoephedrine). These drugs do not cause the development of drug-induced rhinitis. Under their influence, due to the stimulating effect on the alpha1-adrenoreceptors of the vascular wall, there is a narrowing of the vessels, a decrease in their permeability and, as a result, a decrease in the swelling of the mucous membrane of the nasal cavity, which helps to facilitate nasal breathing.

Individual tolerance of alpha1-adrenoreceptor agonists varies considerably. It should be noted that phenylephrine has a favorable safety profile when used in recommended doses compared to other vasoconstrictors. Thus, pseudoephedrine can cause tachycardia and arterial hypertension, as well as increase vascular resistance of cerebral arteries, which is especially dangerous in elderly and senile patients. In addition, phenylpropanolamine and pseudoephedrine can cause arrhythmia, tremor, anxiety, and sleep disturbances. In contrast, the use of phenylephrine in therapeutic doses does not cause such effects. It is especially important to adjust the dose based on age. Thus, the usual dose of pseudoephedrine taken every 6 hours is 15 mg for children 2-5 years old, 30 mg for children 6 to 12 years old, 60 mg for adults. Similar pharmacokinetics are characteristic of phenylpropanolamine. Side effects should be expected primarily in individuals with glaucoma, heart rhythm disturbances, arterial hypertension, and gastrointestinal motility disorders.

In the 3rd period of acute rhinitis, viral-microbial associations play a leading role, therefore, local antibacterial drugs come to the fore in treatment. In rhinitis, drugs for local administration are mainly used. It is undesirable to use drugs containing local glucocorticoids. Mupirocin is produced in the form of an antibacterial ointment adapted for nasal use. It is used 2-3 times a day. Framinetin is used as a nasal spray 4-6 times a day. The drug Polydex with phenylephrine also contains dexamethasone, neomycin, polymyxin B. This drug is produced in the form of a nasal spray. Bioparox contains the bacteriostatic antibiotic fusafungine. It is used 4 times a day.

Rinsing the nasal cavity with a warm 0.9% sodium chloride solution with the addition of antiseptic agents, such as miramistin, dioxidine, octenisept, etc. (the so-called nasal douche) is effective.

Further management

Patients with acute rhinitis should be recognized as temporarily incapacitated. In this case, it is necessary to take into account the profession. Patients whose work is associated with the service sector, food products, as well as with lecturing, singing or with unfavorable working conditions, during acute rhinitis must be released from work for up to 7 days.

Forecast

The prognosis for acute catarrhal rhinitis in adults is generally favorable, although in rare cases the infection may spread from the nose to the paranasal sinuses or to the lower respiratory tract, especially in people prone to pulmonary diseases. A frequently recurring acute process may become chronic. In infancy, acute nasopharyngitis is always dangerous, especially for weakened children predisposed to various pulmonary, allergic and other complications. In older children, the prognosis is usually favorable.

Prevention of acute rhinitis (acute runny nose)

To prevent acute rhinitis, it is necessary to carry out measures aimed at increasing the general and local resistance of the body to adverse environmental factors. A large role in this is played by the gradual hardening of the body to cooling and overheating, humidity and dry air. Hardening should be carried out systematically throughout the year in the form of sports activities or walks in the fresh air, water procedures in order to train the thermoregulatory, as well as respiratory, cardiovascular and other systems of the body. It is very important that clothing matches the weather at different times of the year.

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