[Bell] Welcome back to Coffee Break, the audio equivalent of clearing your head without getting hooked on the spray. The locked names, one square term 'BAM'. You can breathe again. But keep using it too long and your lender more congested than before. That's called rebound congestion and it's surprisingly common. Most nasal decongestants shouldn't be used for more than three to five days. After that, you could actually make these worse. We explain how to come off them safely and what you could try instead. That's all in this episode of Coffee Break. [Music] I'm Dr Jeff Ham and I'm Dr Sam again me. This is season one of Coffee Break. We are two general practitioners from beautiful dogs that are the United Kingdom and we are happy to have you here with us for another Coffee Break. In our show, we give you helpful and useful health and wellness information in short and easily digestible episodes. That's right and hopefully in a fun and enjoyable way as well. In today's VAR to Sea of Health information, we hope to be your trusty island of reliable and impartial independent, unbiased information. And we may even have some guests with us to help. So sit back and enjoy. Hey Coffee Break! [Music] Well, we've all been there. Blocknose, congested and you feel like you can't breathe. Sleeping is difficult and you need a quick fix. It's very tempting isn't it to reach for a navel to the congestions? Yes. You've heard they work fast. You've seen the adverts and they work well. And in fact, you probably know somebody who uses them pretty much every day. So they've got to be good. And that brings us on to how do they actually work and what makes them risky? Yes indeed. So let's look at the most common options. So the most common over-counter-de-congestant, which is a spray contains oxymetazoline, or zylamatazoline. Or there are some tablets. So there's pseudoephidrine, which also works in a similar way. And how do they work? Well, essentially work by vasoconstriction. So they narrow the blood flow to the area. So when you have a cold or an allergy, the blood vessels in your nasal passages have swollen up, so they've actually dilated, vasodilation. And it's this that actually causes the blocked feeling. And these medicines work against that, no? So degengestions, therefore, are vasoconstrictors. They work by chemically stimulating receptors in the blood vessels in our nasal passages, and that causes them to narrow and shrink. And the result is as the blood vessel shrink, the swelling goes down, the nasal passage open up. And it can breathe again. And it feels like an instant and very effective relief. We always tend to think that nasal congestion must be due to lots of mucus in our noses, but actually it's mainly due to the swelling, isn't it? Because these swollen blood vessels that lead to the congested feeling, and that's why these medications work so well. Indeed. Yeah. Brilliant. Fantastic. So what's the problem? Well, there's something called rebound congestion, or medically known as rhinitis, and then the acrobatic amentosa. Rebound congestion is a condition of nasal congestion, actually caused by using the decongestant itself. So how does that happen? Well, what happens is you get reduced sensitivity. So in three to five days of using the spray, the medicine, the blood vessels in your nose will become less responsive to the medication, also known as tachyphylaxis, for anyone interested. So the dose of drugs wearing off, the blood vessels don't just return to normal. They actually rebound. They swell up even more than what they originally were swollen to. And so you then find yourself in a vicious cycle. The severe rebound makes everything feel worse and intensely congested. So you get the spray out again, you spray up your nose, it works for a short time, then it wears off and the rebound effect comes on again, and you find yourself in a, essentially a physical dependent state, don't you? You've become reliant on the spray, not to treat your cold, but to actually treat the congestion caused by the spray zone withdrawal. Exactly. It's a bit of a fast-dune bargain. You get that instant relief for three days, but you continue. You risk getting that chronic problem that is actually much worse and much harder to solve than the original cold. So how common is this problem? Surely it can't be very common because you, in the UK, certainly you can buy the decongestant spray from everyone, the supermarket, the shops you can buy them. Well, it's very difficult with this sort of condition to be exact on prevalence, on numbers. And many people don't see clearance, they don't talk about it, there's no official diagnosis. But research does give us a very clear picture of widespread misuse, direct cause of rebound congestion. So studies and inos and threat specialists estimate that rhinitis, accomentose, rebound congestion may be present in 7% of the general population. In ENT clinics, that number is much higher, so we can refer to CNT specialists because of this congestion. And some clinics interestingly report that up to 15% of patients present them in nasal obstruction, actually, and this condition. And there's a high rate of misuse. This is even more where one study from Saudi Arabia found that, while most users, that's 70%, use their decongestants for the recommended time or less, a significant, at least, 15% use of the 5 to 15 days, which puts them right in the middle of getting them to have that risk for development. Which is understandably a thoroughly miserable condition, isn't it? Well, it's a certain, yeah. So many stories start the same way, the simple cold or an allergy, and then you get this suffocation for you. So the most reported feeling from long-term users is this profound sense of panic when they've not bought their spray. They describe rebound congestion not as a stuffy nose, but almost like they've been suffocated, or having their nostrils completely fuller at long times, for all the cement. And then they become psychologically attached to the sprays, use the report, having their lives revolve around the spray, their homebuck in their car, where they're in their bed, they're in their drawer, they won't be able to go anywhere without having a spray nearby. And if they've not got it, it's just completely anxiety. If you've left the house, you're not going to unmute, if you've found that you've run out. Just stuck. Yeah, you're stuck, aren't you? And that's got a real financial impact as well. I think one man in the UK carefully said he was spending about £1200 a year on these nasal sprays. He's a huge person. He's, so he's dependently lasted 18 months at the start of the simple cold. It became so severe that his doctor actually said that damaged his nasal tissue was comparable to that. Are they heavy cocaine, use them? And he actually needed surgery to fix his condition. Yes, amazing. It is, really. Yeah. It's not just a bad habit, is it? It's actually a dependence syndrome, really. Yeah, it is. And people who are reliant on sprays aren't just addicts in the typical sense. They do experience severe physical withdrawal, though. And that makes it very difficult to stop. It's a physical dependence. Yeah. Yeah. And it's interesting if we look at how other countries then regulate the use of decongestants. So let's go to our neighbours in France. They have a very strict regulation. Their health agency has taken an incredibly strong stance due to links between basic instructors and rare but serious cardiovascular risks. Wow. So oral decongestants, so that's things like pseudo effigrant tablets. As of December 2024, all oral decongestants containing pseudo effigrant are now prescription- Oh, it's really interesting, isn't it? In the UK, you can buy those over the counter at your pharmacy. But France is taking a very strict view on that. And the reason is, because there was a review that confirmed this small, significant risk of heart attack or strokes, if you're using them too much. They decided the risk, however rare, was unacceptable for a drug but actually treats what is essentially a non-serious condition like a confold. Naysal sprays, so they're basically for treated to nasal sprays. They already been prescription only in France for several years. There's just no way against them with that prescription. Yeah. It was really interesting. In the UK, well, the approach is a little bit different to that. So it's essentially looking at controlling access and quantity rather than actually banning prescriptions entirely. So they're like paracetamol, really, isn't it? Shops and pharmacies will only sell a certain number of packets. They're relying on pharmacists, being aware of who's collecting the medication and asking questions to try and help ensure it's being used appropriately. And there are legal limits on the amount that can be sold at one transaction, so you can't actually buy more than 720 milligrams of pseudiatric in one go. And that's to prevent misuse and stoppiling. But it is interesting, isn't it? Because it was said in the UK, you can buy nasal sprays. But easily you can buy them in bulk from online retailers. And there is no limitation or strictual regulation of who can buy and how many you can buy in the UK. In the United States, oral pseudometric prevalence are sold over the counter, but it is kept behind the counter. You actually have to show ID to buy it and sales
of sugar effigy in time as I'll log to the National Database. Now, actually, this is more to prevent its use in the illegal manufacturer of recreational drugs, but it does also serve as a bad casual overviews. I think it's also important to be aware that sugar effigy in which is the oil form is banned in many common-owned accounting products in many countries and bring them into countries illegal and can lead to your arrests, as well as seizures of medications if you try and take them into account. You're even innocent. Very intriguing. Yeah. So, should we look at the withdrawal process, how do people actually come off of this medicine? It's difficult isn't it? Because actually, as we say, people are physically dependent. Yes. This rhyme is being able to not be able to breathe, so it's very difficult to stop something that's giving you the ability to breathe. So, the first way is polterkeys, and it's just stopping you from spreading it, just stopping it once. I think that's the best. The best. Yeah. It is described as an awful way of doing it. It's horrible, brutal, miserable, and people who do it this way report days or weeks of complete days or blockage where they feel they can breathe through their nose at all. This leads to sweetness nights, mouth breathing as well because you're trying to breathe through your mouth and so on with the nose. This leads to painful glides, roads, but the good news is after that initial hump, the swelling rapidly decreases and you do start for a better. So, it's an option, but doesn't sound ideal. What about the other option, which is a one nostril at a time procedure? So, this is often recommended as a weaning method. You stop using the spray and one nostril completely, continue to use it in the other side, or in the blocked nostril as needed. Now, some reports that this method is much more manageable. The quitting nostril goes through that horrible withdrawal feeling, but you can still breathe and sleep using the treated nostril. After about a week, then the quitting nostril recovers and opens up and at that point you can repeat the process, stopping the spray in the second nostril. It is a longer process, but causes much less panic in misery for the person, doesn't it? It's hard, isn't it? How would you prefer to have a longer process where you can only breathe through one nostril? Yeah. How would you prefer short, sagible process where you feel like you can't breathe through, either? I think it's difficult. Yes. I think it is very difficult. And there are some aids for quitting as well. Certainly your clenched mind suggests some of these saline rinses. Yeah. So, there are saline rinses, kits, there are saline nays and sprays. These flush the nasal passages with saline solution, which physically washes any mucus out. It also helps to inflammation in the tissues. Yes. There are steroid sprays which we get over the counter. These aren't decadjustins, and we use these as an anthropobamish behaviour and other forms of bionitis, so inflammation removes. They don't provide instant release, they're not like a decadjustin, but if you use a daily, they will help reduce that swelling over the next couple of weeks. It just makes that withdrawal process much more bearable. Yeah. And then, sleeping elevated, I think people would suggest that if you, problems particularly about an eye can be sleep upon two or three pillows, apparently more often the help will reduce that swelling in your tube. Yeah. And what about simple things like menthol, vapor, or just with sort of cooling effects, those sort of things that can imagine that helpful? I think anything really helps. Yes. It's an easier thing. Yeah. Anything to reduce, even just to reduce the sensation of it, isn't it? Yes. Okay. Any take-home messages from this episode? I think it's really important to understand that if you're tempted to buy one of these sprays, it's completely acknowledged that it's a distressing symptom nasal stuffiness, isn't it? But underlying it is a very serious potential side effects, increases in your blood pressure, I don't think we actually mentioned it, but actually it can increase your blood pressure. And if you're on medication for that, you should think seriously before starting any of these sort of nasal sprays. So just be careful. I'd say my take-home points again. I think we're looking at some of the packaging on these sprays, by I was looking at one in researching this episode and there wasn't really a very strong, do not use for a long period of time. It was phrases, it's not recommended to use it for more than seven days. Another one was very quite clear, so do not use it for more than seven days, but it was a bit sort of loose. It wasn't quite as strong as maybe it should have been. For something that is actually very, very serious, you know, these in long-term use can cause quite serious damage to your nose. And in some cases, they end up with a lot of surgery. But if you even didn't go that far, you may still have this really difficult time not able to breathe in the area you congested. The other thing I was going to say is that when you do successfully re-versize off these, you may then be tempted when you get a contract for them. I am just saying to people that if you're going to be really careful, don't use as more than three days, that's a simple thing, isn't it? Any way to use a different way of saying it, is there a way to instate these things? Yes. This has been an episode of Coffee Break and we hope you've enjoyed it. And if you have, then I hope you'll join us for another Coffee Break soon. Remember, if you want to get in touch with us or if you have any ideas or suggestions, then please feel free to email us at the show. At
[email protected]. You can listen to us and subscribe to the show on any of the podcast platforms and via your computer, smartphone and home smart devices. We have used a variety of resources for the information in the show to try and assure that it is up to date and the most applicable. We have also put any information links we have discussed in the show. Coffee Break is a coffee break production and is edited and produced by Ming.jephan. It's created written and hosted by.jephan and me. Dr. Sam McGinley. All the content we provide in the show is for General Information Purbs' only. The content does not constitute medical or healthcare advice. The content is valid in England at the time of recording. The content should not be relied upon as a substitute for professional medical or health care advice applicable to your specific circumstances. We advise that you always consult a qualified medical professional for any medical matters.
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