Congestion, as a symptom of upper
respiratory tract diseases including seasonal and
perennial allergic rhinitis, acute and chronic
rhinosinusitis, and nasal polyposis, is principally caused by mucosal
inflammation. Though effective
pharmacotherapy options exist, no agent is universally efficacious; therapeutic decisions must account for individual patient preferences. Oral H(1)-antihistamines, though effective for the common symptoms of
allergic rhinitis, have modest
decongestant action, as do
leukotriene receptor antagonists. Intranasal
antihistamines appear to improve congestion better than oral forms. Topical
decongestants reduce congestion associated with
allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral
decongestants show some efficacy against congestion in
allergic rhinitis and the
common cold, and can be combined with oral
antihistamines. Intranasal
corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with
allergic rhinitis, and show some congestion relief in
rhinosinusitis and nasal polyposis.
Immunotherapy and surgery may be used in some cases refractory to
pharmacotherapy. Steps in congestion management include (1) diagnosis of the cause(s), (2) patient education and monitoring, (3) avoidance of environmental triggers where possible, (4)
pharmacotherapy, and (5)
immunotherapy (for patients with
allergic rhinitis) or surgery for patients whose condition is otherwise uncontrolled.