From the Guidelines
The patient's green boogers are likely a result of a vigorous inflammatory response to a viral rhinosinusitis (VRS) infection, which can cause discolored nasal discharge without the presence of bacteria. According to the clinical practice guideline update on adult sinusitis 1, nasal purulence alone does not indicate a bacterial infection, and the coloration of nasal discharge is related to the presence of neutrophils, not bacteria.
Causes of Green Boogers
- The green color comes from the presence of an enzyme called myeloperoxidase, which is released by white blood cells as part of the body's normal immune response.
- Common non-infectious causes include allergies, environmental irritants, dry air, and structural issues like a deviated septum.
- VRS promotes a vigorous inflammatory response, causing epithelial disruption, edema, and excessive mucus production, which further impairs normal ciliary function 1.
Management of Symptoms
- Management of VRS is primarily directed toward relief of symptoms, and antibiotics are not recommended for treating VRS since they are ineffective for viral illness and do not provide direct symptom relief 1.
- Palliative medications—such as analgesics, anti-inflammatory agents, nasal saline, decongestants, antihistamines, mucolytics, cough suppressants, and topical or oral corticosteroids—may be used alone or in varying combinations for symptom relief.
- Topical intranasal steroids may have a role in managing VRS, even though they do not have a Food and Drug Administration (FDA) indication for this purpose, and can relieve facial pain and nasal congestion in patients with rhinitis and acute sinusitis 1.
When to Consult a Healthcare Provider
- If the green discharge persists for more than 10-14 days, is accompanied by fever, facial pain, or severe headache, it would be advisable to consult a healthcare provider to rule out a developing infection.
- For symptom relief, saline nasal sprays, staying hydrated, using a humidifier, and avoiding known allergens or irritants can be helpful.
From the Research
Possible Causes of Green Boogers
- The presence of green boogers in a patient does not necessarily indicate an infection, as the color can be caused by the presence of an antioxidant enzyme called myeloperoxidase, which is found in neutrophils, a type of white blood cell 2.
- Another possible cause of green boogers is the presence of pus, which can be a sign of a viral or bacterial infection, but it can also be caused by other factors such as allergies or environmental irritants.
Role of Nasal Saline Irrigation
- Nasal saline irrigation has been shown to be effective in reducing the severity of upper respiratory tract infection (URTI) symptoms in children, and may also be beneficial in reducing the severity of allergic rhinitis symptoms 3, 4.
- The use of nasal saline irrigation can help to thin mucous, improve mucociliary clearance, and reduce antigen load in the nasal and sinus cavities, which can help to alleviate symptoms 5.
Limitations of Current Evidence
- There is limited evidence available to determine the optimal method of nasal saline irrigation delivery, including the ideal volume, pressure, frequency, and duration of use 5.
- Further research is needed to fully understand the benefits and limitations of nasal saline irrigation in the treatment of URTIs and other respiratory conditions 3, 2.