Acute rhinitis (acute rhinitis): treatment and prevention

Objectives of treatment of acute rhinitis

Treatment of acute rhinitis is aimed at arresting the painful symptoms of acute rhinitis, reducing the duration of the disease.

Indications for hospitalization

Acute rhinitis is usually treated as an outpatient. In rare cases of a severe cold accompanied by a significant increase in body temperature, a bed rest is recommended. It is better for the patient to allocate a room with warm and moistened air, which reduces the painful feeling of dryness, tension and burning in the nose. Do not eat spicy, irritating food. It is necessary to monitor the timeliness of physiological items (stool, urination). During the closing of the nasal passages, one does not need to forcibly breathe through the nose, blowing should be done without much effort and at one point only through one half of the nose, so as not to throw the pathological discharge through the auditory tubes into the middle ear.

Non-drug treatment of acute rhinitis

The abortive course of acute catarrhal rhinitis for the first time days can be facilitated by applying thermal, distracting and sweating procedures. Assign a hot general or foot (hand, lumbar) bath, immediately after which the patient drinks hot tea, then takes inwards 0.5-1.0 g of acetylsalicylic acid dissolved in water or 1.0 g of paracetamol. Then the patient should lie down in a warm bed, wrapped up in a blanket. In order to influence the neuro-reflex reactions in the nose, ultraviolet irradiation of the soles of the feet (in erythematous doses), mustard plasters on the gastrocnemions, ultraviolet irradiation, UHF or diathermy on the nose, etc. Are also used. All these agents are more effective in 1 stage of acute catarrhal rhinitis, however their beneficial effect can be useful also in the second stage.

Medical treatment of acute rhinitis

Drug treatment has certain differences in children and adults. In infants from the first day of acute rhinopharyngitis, the most important task is the restoration of nasal breathing during periods of breastfeeding, which not only helps to ensure normal nutrition, but also counteracts the spread of inflammation to the auditory tubes and the middle ear, as well as the lower respiratory tract. To this end, it is necessary to suck off the mucus from each half of the child's nose before each feeding. If on the threshold of the nose there are crusts, gently soften them with sweet almond oil or olive oil and remove with a cotton ball. 5 minutes before feeding, 2 drops of vasoconstrictor are poured into both halves of the nose: 0.01-0.02% solution of epinephrine and 2 drops of 1% boric acid solution (can be taken together). Between the feedings, 4 drops of 1% solution of collargol or silver proteinate 4 times a day are poured into each half of the nose. This substance, enveloping the mucous membrane of the nose and partially the pharynx, has astringent and antimicrobial effect, which reduces the amount of detachable and has a beneficial effect on the course of the disease. You can use a 20% solution of the albucid. A good vasoconstrictive effect is given by 1% solution of ephedrine and other preparations of identical action,

In adults, the main goal of treatment at the first stage of rhinitis is considered to prevent the invasion of the virus and its replication in the epithelial cells of the nasal mucosa. This can be achieved through the activation of nonspecific local defense factors (mucociliary transport, secretory antibodies, immunocompetent cells, etc.) and the use of antiviral drugs.

Antiviral drugs:

• natural interferons (human leukocyte interferon);
• recombinant interferons (interferon alfa-2, etc.);
• interferon inducers [tilorone (inside), meglumine acridon acetate (gel on the nasal mucosa)]:
• antiviral immunoglobulins;
• oxoline - a virucidal preparation, destroys extracellular forms of herpes viruses and rhinoviruses, is used as a preventive agent;
• rimantadine acts on influenza A viruses;
• Acyclovir selectively affects herpesviruses:
• aminocaproic acid binds to the receptors of target cells, disrupts the interaction of the body and the virus. Used for irrigation of the nasal mucosa and pharynx,

Nevertheless, the main means of treating rhinitis in this, however, as well as in the remaining stages, is considered to be vasoconstrictors. To remove nasal congestion apply a variety of vasoconstrictor. With sinusitis, preference is given to local nasal vasoconstrictor drugs. This group of funds includes:

• alpha1-ndrenoreceptor agonists (phenylephrine);
• alpha2-adrenoreceptor agonists (xylometazoline, naphazoline, oxymetazoline);
• alpha, beta-adrenoreceptor agonists (epinephrine);
• drugs that promote the release of norepinephrine (ephedrine);
• drugs that prevent the recycling of noradrenalia (cocaine).

Phenylephrine, having a mild vasoconstrictive effect, does not cause a significant decrease in blood flow in the nasal mucosa, therefore its curative effect is less pronounced and less prolonged. More pronounced therapeutic effect in comparison with other vasoconstrictive drugs have oxymetazolium derivatives. The longer-term effect of α2-adrenoreceptor agonists is attributed to their delayed clearance from the nasal cavity due to decreased blood flow in the mucosa. Moreover, for practical use, preparations produced in the form of nasal sprays are more convenient, which make it possible to reduce the total dose of the drug administered due to a more even distribution on the surface of the mucous membrane. Epinephrine and cocaine are not used in everyday medical practice.

Infusions of drugs do 3 times a day for 5 drops in each half of the nose or in one half (in a one-way process). Before infusion and after 5 minutes after applying drops, it is recommended to blow your nose well. Drops should be buried in the lying position with the head thrown back. This position provides a better penetration of the drug to the sinuses 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 (more than 10 days) use of these drugs can cause the development of nasal hyperactivity, changes in the histological structure of the mucous membrane, that is, cause the development of drug rhinitis. If necessary, it is better to replace vasoconstrictive drops with astringent preparations (3% solution of collargol or silver proteinate, which is used in the same way as drops).

It is acceptable to use systemic vasoconstrictors (phenylephrine, phenylprolanolamine, ephedrine, pseudoephedrine). These drugs do not cause the development of drug rhinitis. Under their influence, due to the stimulating effect on the alpha1-adrenergic receptors of the vascular wall, the vessels contract, reduce their permeability and, as a consequence, reduce the swelling of the mucous membrane of the nasal cavity, which facilitates the relief of nasal breathing.

Individual tolerance of alpha 1 -adrenoceptor agonists varies considerably. It should be noted the favorable safety profile of phenylephrine. When it is used in recommended doses compared with other vasoconstrictors. So, pseudoephedrine can cause the development of tachycardia and hypertension, as well as increase the vascular resistance of the cerebral arteries, which is especially dangerous in elderly and senile patients. In addition, phenylpropanolamine and pseudoephedrine can cause arrhythmias, tremors, feelings of anxiety and sleep disorders. On the contrary, the use of phenylzrin in therapeutic doses of such effects does not cause. It is especially important to adjust the dose with age. Thus, the usual dose of pseudoephedrine taken every 6 hours is 15 mg for children 2-5 years, 30 mg for children 6-12 years, 60 mg for adults. A similar pharmacokinetics is also characteristic of phenylpropanolamine. Manifestations of side effects should be expected primarily in individuals with glaucoma, heart rhythm disturbances, arterial hypertension, disorders of motility of the gastrointestinal tract,

In the 3rd period of acute rhinitis, the leading role is played by virus-microbial associations, therefore, in the treatment, local antibacterial drugs come to the fore. When rhinitis is used primarily preparations for topical administration. It is undesirable to use preparations containing local glucocorticoids, Mupirocin is released as an antibacterial ointment, adapted for nasal administration. Use 2-3 times a day. Freiminetin is used as a nasal spray 4-6 times a day. The preparation of polidex with phenylephrine also contains dexamethasone, neomycia, polymyxin B. It is produced as a nasal spray. Bioparox contains bacteriostatic antibiotic fusafungin. It is used 4 times a day.

Effective washing of the nasal cavity with a warm 0.9% solution of sodium chloride with the addition of antiseptic agents, for example miramistine, dioxidine, octenidecept, etc. (so-called nasal douche)

Further management

Patients with acute rhinitis should be recognized as temporarily incapacitated. At the same time, one must take into account the profession. Patients whose work is interspersed with the field of service, food, as well as reading lectures, singing or with unfavorable working conditions, during an acute cold should necessarily be released from work for up to 7 days.

Forecast

The prognosis for acute catarrhal rhinitis in adults is usually favorable, although in rare cases it is possible to transfer infection from the nose to the paranasal sinuses or to the lower respiratory tract, especially in persons prone to lung diseases. Often recurring acute process can go into a chronic form. 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 cold)

For the prevention of acute rhinitis, it is necessary to carry out measures aimed at increasing the overall and local resistance of the organism to unfavorable environmental factors. A big role in this is the gradual hardening of the body for cooling and overheating, humidity and air dryness. Hardening should be carried out systematically throughout the year in the form of sport activities or outdoor walks, water procedures for the purpose of training thermoregulatory, as well as respiratory, cardiovascular and other body systems. It is very important that clothes match the weather at different times of the year.

[1], [2], [3], [4], [5], [6], [7]