How Good is your Nasal Spray Technique?
Friday, March 16, 2007 at 10:48AM Spring is in the air. Soon we will be able to put away the coats, sweaters and long underwear for another three seasons. Unfortunately, the bad news is pollens and molds are poised to explode into the air and spoil the fun for millions of people in the upper half of the United States. Trees are the first to pollinate in the mid-west, as early as February if a warm spell hits. There was too much cold weather and snow to allow for pollen generation in February this year, but a few spurts have already occurred this month (March).
How can you prepare for the pollen and mold season of 2007? The key is, to attempt to prepare. Many people let their allergy season catch them by surprise. They find themselves with outdated medicine or empty bottles of antihistamines and nasal sprays (prescribed kind). Of course with the peak allergy season, it takes weeks to get in to see your allergist. Out of desperation, over the counter medications are purchased for short term relief. Are you familiar with this scenario?
Well, if you were fortunate enough to have planned ahead, you had your pre-spring follow-up appointment (in January or February) and discussed how and when to start medications with your doctor. I have patients that are allergic to trees begin their prescribed allergy medications March 15th, if they are allergic to certain types of trees (such as elm or cottonwood). I warn them to start earlier, if the forecast is for warm weather in February (not this year huh?).
I also review nasal spray technique with all my patients. Many allergy sufferers have prescriptions for nasal steroid sprays (for example Flonase, Nasacort, Nasonex, Rhinocort and others). If your technique is poor, you will not fully respond to the nasal spray. Seasonal allergy nasal symptoms require regular (daily) nasal spray use for most of these preparations. If you use them only as needed, you may not approach the level of relief achieved with regular use.
I also emphasize the importance of timing. Using these nasal sprays first thing in the morning or at the end of the day may limit your response because the nose is not clear at the time. The nose has many functions, one of which is to filter the air (for the lung). The nose is most clear after a shower or bath. If one clears there nose after the bath or shower (blow into tissue) the inner surface is better prepared to receive the medicated spray. Isn't your nose kind of congested and cluttered when you first awaken? Not a good time to do nasal sprays my friends.
What about your technique? Do you lean your head back and spray the medication into the nose (basically down your throat)? This is terrible technique if you do that. I advise patients to more properly position the nasal spray by placing just the tip (not the entire nose piece) of the nozzle into the nose aiming slightly away from the nasal septum (the midline wall that divides your nostrils into left and right sides). See the pic below, illustrating good positioning of the nasal spray. It is important not to spray these medications into your nasal septum. This reduces the effectiveness and may cause irritation and bleeding from the nose. If you use your left hand to spray into the right nostril (palm facing the face), it is easier to spray the medicine properly. Have your allergist check your procedure on follow-up visits. It is not real easy to pick up this technique by written instruction which is why most people are not properly using their nasal sprays.
Realize that intranasal steroids take several days to weeks to reach a peak effect. Do not stop too soon (under 3-4 weeks) thinking it will never work. If you got a late start (began the medication after starting to have allergy symptoms) it takes longer to respond. Often the combination of antihistamine and intranasal steroid is recommended for more moderate to severe hayfever. Your allergist is aware of a number of other alternatives (medications and procedures such as nasal saline rinses) and will also review environmental controls.
Finally, avoid the over the counter, quick acting nasal sprays formulated for rapid decongestion of the nose. These tend to be habit forming and are very rough on the inner surface of the nose when used too long (more than three days at a time). Did you know there is a diagnosis for people that overuse such nasal sprays? It is called Rhinitis Medicamentosa. I see about ten patients a year, that have this problem and it is not easy to treat.
Intranasal steroids are not addictive and are often used, along with other medications, to treat patients with Rhinitis Medicamentosa (patients addicted to over the counter nasal spray decongestants). Of course, intranasal steroid sprays require a prescription. Your doctor should periodically check your inner nasal passages to make sure there are no signs of irritation. The intranasal steroids are generallly well tolerated. Many formulations may be used in children down to age 6 (some formulations to age 4 and 2).
Intranasal steroids have become cornerstone to managing seasonal and perennial allergic rhinitis (hayfever). Consistency, timing and proper technique are keys to a successful outcome. Follow-up with your prescribing doctor for maintenance checks.
Reader Comments (15)
So far after reading this article I still am very skeptical about buying my medications online. My main concern is will I get my medication on time? What if it doesn't come for weeks and weeks?I read up on "kiwi drug" about a over the counter Flonase.http://www.kiwidrug.com/search/flonase/ Is this just as good as the stuff my Doctor prescribes me?
E,
Thanks for commenting. There is not an easy answer to your question but I'm inclined to say avoid the online allergy meds. You see, it is difficult to know what you are getting, who is making it, sending it and repsonsible for its quality, preservation, potency and purity. The FDA sets standards for all prescribed drugs (and some over the counter ones). Many of the online drugs are not regulated at all. If something goes wrong who do you report to? Who is responsible? Although prescribed meds are more expensive, they are better regulated and offer you more routes to track and deal with unexpected pitfalls. You can address issues concerning the drug through the prescribing doctor, pharmacist, FDA, pharmaceutical company as well as online.
I hope I addressed your concerns. Let me know if not.
J. Thompson, MD
Been trying to cope with dust allergies for a few years now post-op, operation worked a treat for 5-6 months, total life changer, sadly problems came back which was expected. Trying different techniques sometimes have an instant effect but swelling / problems still come back, I can't seem to get any consistency, I'll give your technique a go and see what happens :)
2-3 years from now we'll have the "all in 1" injection and fingers crossed that does the job, working on diet in the mean time as a final solution.
Cheers for advice,
Paul.
Good Luck Paul!
Give it a few weeks before the final assessment.
Then hit me back.
Best Wishes,
J. Thompson
Thanks, I'll keep you updated for sure. I'm close to seeing my consultant though who did the operation, I think I'll wait and see what the results are regarding the technique, although I'm stuck at the moment, sometimes my nose is clear, but I have an insanely bad headache, sometimes my nose is totally blocked and my head isn't as bad. I've tried everything I feel and the only thing that totally helped was the op, but is 6 months of total bliss worth the insurance hit (I saw the consultant on the NHS here in UK, around Feb, still waiting for the CT scan 7 months on.) I saw him in June, privately and I stopped medication to add more for him to see on the day, it actually made my nose clearer, near perfection for a few days but I always knew it'd come back. I'm allergic to dust which is probably the worst thing, just can't avoid it, should live in an "allergy free dome" :D Anyway don't want to bore you, thanks again for the advice and I'll let you know how it goes :)
Regards,
Paul.
Dr. Thompson,
Thanks for the advice on using nasal sprays. I am curious to know how effective Nasacort AQ is in opening up blocked/swollen Eustachian tubes and how long before effects are noticed. I went to the Dr. several weeks ago for stopped-up ears and he said my problem is allergy-related. He said the Eustachian tubes are blocked/swollen and not properly draining the fluid from my ears. I've not had any other allergy symptoms such as stuffy/runny nose, itchy/watery eyes, etc. -- just the stopped-up ears. He gave me a Kenalog injection, which he said should clear up the problem, but it hasn't. I was also given some sample packs of Nasacort AQ and an antihistamine called Clarinex. He also mentioned OTC Zyrtec or Zyrtec-D as a possibility. A family friend who is an ENT suggested using the Nasacort only.
In your opinion, which is the best approach to speeding up the opening of the Eustachian tubes? Is a combination of meds the best way or will the Nasacort itself suffice? Are OTC decongestants containing pseudoephedrine effective and can they be used at the same time with the Nasacort? I saw my GP again yesterday and he also said I might try Medrol, but I am reluctant to use an oral steroid because of the possible side effects.
Regards,
Susanne
Hi Susanne,
I try to avoid giving medical advice through this medium. I need more information, as well as the benefit of examining you in order to give cogent advice. That said, I believe in such combinations of sudafed (if no history of thyroid problems, heart or blood pressure problems) along with nasal steroid spray and antihistamine (if allergic sensitivity has been documented) for my patients who have similar complaints..
If the above medicine intervention is not successful I refer patients to an ENT specialist for full evaluation. Eustachian tube dysfunction may be difficult to manage when it is an isolated issue. I would want to rule out chronic sinusitis, which may be subtle regarding symptoms.
Good Luck, and please give some follow-up commentary in the future.
J. Thompson, MD
Hey just an update on how the technique is progressing, it definitely made a difference but I still felt like I was at 60%, however recently I've started using my neti pot again, and after finding this link:
http://yoga108.org/pages/show/106-how-to-use-a-neti-pot-without-danger
I've had 2 days of bliss and haven't gone the week of rinsing yet, my problem is never being able to clear my sinuses and nasal passages for nasonex to have it's full effect. But now it's just awesome, really awesome, as mentioned previously I have all year round allergies and this is the best I've felt for a long time, apart from the odd day of trying something new and it working for a few days.
Stage 2 of the neti pot isn't pretty but I get the impression you won't have to do it every day, however I am doing it everyday for the first week and see what happens when I miss a day or two.
Hope anyone reading this gets the same results as I have (especially those who have had the operation, it's worked, and then symptoms returned).
All the best,
Paul.
Although, I haven't done the 3 day test yet, many a time has something worked for 1-2 days and the 3rd day I'm back to square one, but we'll see!
Glad you have found success Paul. I have a posting on this site about the Neti Pot. It is a tremendous help for some people that have chronic nasal problems.
Thanks for the update. I hope your progress continues.
Good Luck,
James T. MD.
Sadly 2 and a bit days of bliss is all I got, at least I know it's possible. I think I'll have to hang tight until the injection that's being tested in Switzerland comes to the UK in a couple years, I'm really stumped. What I've noticed is the worst part of Sinusitis is when it is in the process of it returning, one end of the spectrum is everything is blocked and your body has kind of got used to it, compromise I guess, and the other end is perfection which I'd kill for personally!
I don't think it's worth having an operation / clean out again due to the fact it'll return whether in a month or more, really disappointed if I'm honest, thought I'd finally got somewhere with the combination of your advice and the nasal rinse technique.
Your advice is much appreciated, thank you for your time! :)
Regards,
Paul.
p.s. Have an awesome Christmas! And a Happy New Year!!
Sorry Paul,
Wish you had experienced sustained improvement. I think you really need the assistance of a motivated, board certified allergist. Allergist don't do surgery so we are forced to blend conservative measures with medications. There is a formula out there, that should work for you but it requires further evaluation and adjustment of your medications. If you are not ready to give up yet, seek the help of a board certified allergist. If you already see one, pay him/her another visit.
Best to you and Happy Holidays to you too!
James T.
hello
i am really glad you posted this so i could write to you. i hope that you can help me. i have taken a nasal steroid for years but the last 2 years i have had problems taking the spray. i spray it and it does not go on my inferior turbinate but on my septum or somewhere else in my nose. i get jaw pain and tingling in my lips . its terrible and worst of all i get the inside nose irritation and my symptoms are bad. i have non allergic rhinitus and i seem to only have this problem with taking it properly in the one nostril. i have had deviated septum surgery so my septum is somewhat straight, much better than b4 anyways. and i just cant seem to get it right no matter what instructions i follow. I can however always get the right nostril right no matter what. it almost seems that i get upset or what not then i cant take it right in the left nostril. i know at this point this has become an obsession and i cant control it. i dont know what to do i just wnat to take the spray right.
Hi Jackie,
Please excuse the extremely long delay in addressing your comment. You have a very uncommon problem which obviously complicates your achievement of control regarding nasal inflammation. The left side of your knows is apparently very sensitive to nasal spray. On occasions when I have encountered this in the office, I have tried different brands of nasal sprays. Some brands have fewer preservatives and are fragrance free (for example, Nasonex, Nasacort AQ , Rhinocort AQ and Veramyst). Veramyst in addition, has a more finer (very light mist) and less forceful spray.
Sometimes timing the spray after nasal rinsing with saline can be helpful. Are you certain you have the technique down? Have you had an allergist or ENT doctor observe your nasal spray technique?
I recommend you discuss these points with your doctor. The above nasal sprays (except for saline of course) are only available by prescription. Furthermore, if you have not seen an allergy specialist Look Into It.
Best Wishes,
J. Thompson, MD