Nasal Spray Addiction: Is It Real?

Nasal decongestant sprays are used to help reduce the symptoms of a blocked nose which occurs due to increased blood flow to the mucous membranes of the nasal passages.

This symptom occurs when the patient is affected by any condition which irritates, inflames of infects the nasal mucosa (rhinitis) or due to physical obstruction around the nasal passages. These include the following medical conditions: 

• Allergies or hay fever.
• Viral infections such as the common cold, influenza and RSV. The latter occurs most frequently in children.
• Bacterial infections of the upper respiratory tract system such as acute sinusitis.
• Chronic sinusitis.
• Exposure to chemical irritants.
• Exposure to environmental irritants such as pollution and tobacco smoke.
• Nasal polyps.
• Enlarged adenoids.
• A deviated septum.

How do nasal decongestants work?

Nasal decongestant sprays contain medications which are very potent constrictors of the blood vessels of the nasal mucosa. These medications then cause blood to drain from the nasal mucous membranes back to the body and thus results in the swollen nasal passages to reduce in size. This action then allows for relief of the symptom and the patient can breathe easier through the nose.

The are many nasal decongestants available on the market but, ultimately, they all have the same mechanism of action at the end of the day. The active medications which are contained in these sprays can be found on the package insert of the product. These medications can include the following:

• Oxymetazoline
• Xylometazoline
• Neosynephrine
• Phenylephrine

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How do nasal sprays cause nasal obstruction?

Persistent use of these sprays then leads to prolonged blood flow reduction to the nasal passages. This results in decreased oxygen and nutrient supply to these tissues. The result of this situation is a condition called rhinitis medicamentosa. 

The mucous membranes of the nasal passages try to compensate for this reduced supply of oxygen and nutrients by forming new blood vessels to facilitate increased blood flow. A vicious cycle then develops because these new vessels result in further swelling of the nasal passages. The patient, thinking that the medication isn't working, then keeps using more of the nasal decongestant spray over a longer period of time to bring relief to their symptoms. 

Side-effects and complications

Persistent swelling of the nasal tissue can lead to blockage of the Eustachian tubes. This can cause the patient to experience symptoms of persistently blocked ears due to resultant pressure changes in these tubes.

Long-term use of these sprays results in physical changes of the nasal anatomy. Issues such as a saddle nose deformity or perforation of nasal septum can occur due to decreased blood flow to these areas.

Management Of Persistent Nasal Spray Use

It needs to be understood from early on that this process can last from a few weeks up to a couple of months, and symptoms can include blocked ears and a severely blocked nose. Unfortunately, this isn't a pleasant time but there are medications and home remedies which can help to take over the job of the decongestants and offer relief of the symptoms experienced. If a patient is aware of this situation and has been educated on these issues then it makes the withdrawal process easier to accomplish. 

The following are guidelines and suggestions which can help a patient to stop the persistent use of nasal decongestants, and which can also help to try and reduce the withdrawal and rebound effects. These withdrawal symptoms will begin to resolve within a couple of weeks after stopping use of the sprays and the patient's nasal passages should start functioning normally soon thereafter.

• The patient needs to consult their primary care doctor in order to initiate management of this issue. The reason for this is because the patient will benefit from starting on a course of high-dose oral steroid medication for which a script is needed. The steroid dosage is then down-titrated over the following 3 weeks and this helps to reduce inflammation in the nasal passages. 
• A doctor can also prescribe an antihistamine medication which helps to alleviate blocked nasal passages caused by allergies. This will help to reduce the need for using a decongestant spray.
• Ciclesonide and fluticasone furoate are nasal sprays which contain steroids. These are extremely safe and effective medications which help to reduce inflammation of the nasal mucous membranes. They don't cause any systemic side effects because they are not absorbed by the body, but rather have localized activity where they are sprayed.
• Humidifiers can also be used as breathing in moist air helps to soothe the nasal passages and reduce inflammation. Taking a warm shower produces steam which also helps in the same way a humidifier does.
• Hypertonic saline solutions can also be used in the form of nasal sprays or can be made at home and administered using a neti-pot. They also reduce inflammation in the nasal passages, especially if the cause of the nasal blockage is caused by infective processes.

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• Make sure that plenty of fluids are consumed, especially water, as this helps to keep the patient hydrated and it also helps to thin out nasal secretions which makes it easier to drain. The less pressure there is in the nose, the lower the chances of inflammation and irritation in the nasal passages.
• Warm compresses applied over the forehead and upper part of the nose can help stimulate reduction in the inflammatory process. The heat can also help relieve pain caused by conditions such as sinusitis.