What are the benefits of steroid use in a patient with mild nasal congestion and chills?

Benefits of Steroids in Mild Nasal Congestion and Chills

Steroids are not recommended for patients with mild nasal congestion and chills as they offer minimal benefit while introducing unnecessary risks.

Understanding the Clinical Picture

Mild nasal congestion with chills suggests either:

• Viral rhinosinusitis (common cold)
• Early allergic rhinitis
• Mild acute bacterial rhinosinusitis

Evidence-Based Assessment of Steroid Benefits

Intranasal Steroids

For mild symptoms like those described:

• Intranasal steroids provide modest symptom improvement in established allergic rhinitis or more severe sinusitis, but are not indicated for mild viral symptoms 1
• The number needed to treat for symptom improvement in acute rhinosinusitis is 14, indicating minimal benefit for mild cases 1
• Potential side effects include:
  • Epistaxis (4-8% in short-term use, up to 20% in long-term use)
  • Nasal irritation, dryness, burning
  • Rare septal perforation 1

Systemic Steroids

• Oral steroids as monotherapy are ineffective for acute rhinosinusitis 2
• Systemic steroids should be reserved only for very severe or intractable rhinitis or nasal polyposis 1
• Short courses (5-7 days) may be appropriate for severe symptoms, but not mild presentations 1

Appropriate Management for Mild Nasal Congestion and Chills

First-line Options:

1. Analgesics/antipyretics (acetaminophen, NSAIDs):

   • Provide relief of pain, fever, and some nasal symptoms 1
   • NSAIDs can improve headache, ear pain, joint pain and malaise 1

2. Nasal saline irrigation:

   • Safe, low-cost option that may improve symptoms 1
   • Helps clear mucus and reduce congestion

3. Short-term decongestants (if congestion is bothersome):

   • Oral or topical decongestants can temporarily reduce nasal congestion 1
   • Topical use should be limited to 3-5 days to avoid rebound congestion (rhinitis medicamentosa) 1

For allergic components (if present):

• Second-generation antihistamines may provide relief of sneezing and rhinorrhea 1
• Intranasal antihistamines may be considered for more rapid symptom relief 1

Clinical Decision Algorithm

1. Assess symptom severity and duration:

   • Mild symptoms with recent onset (1-3 days) → supportive care
   • Symptoms persisting >10 days or worsening after 5 days → consider bacterial sinusitis

2. For mild symptoms with chills:

   • Start with acetaminophen or NSAIDs for symptom relief
   • Add saline nasal irrigation
   • Consider short-term decongestants (3-5 days maximum) if congestion is bothersome

3. Monitor for worsening symptoms:

   • Increasing pain, fever, purulent discharge
   • Symptoms persisting beyond 7-10 days

Conclusion

For a patient with mild nasal congestion and chills, steroids (either intranasal or systemic) offer minimal benefit and introduce unnecessary risks. Symptomatic treatment with analgesics, saline irrigation, and short-term decongestants is the appropriate approach based on current evidence.