From the Guidelines
For sinusitis with runny nose and coughing, I recommend starting with analgesics and saline irrigation to provide symptomatic relief, as suggested by the most recent guideline evidence 1.
Treatment Approach
To manage sinusitis symptoms, consider the following:
- Use analgesics to relieve pain and reduce inflammation
- Perform saline nasal irrigation twice daily to flush out mucus and irritants
- Consider using topical nasal steroids, such as fluticasone or triamcinolone, to reduce inflammation in the sinus passages
- For congestion, take pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or phenylephrine if pseudoephedrine is unavailable
- Antihistamines like loratadine (Claritin) or cetirizine (Zyrtec) can help with runny nose, while guaifenesin (Mucinex) 600mg every 12 hours can thin mucus
- For cough, dextromethorphan (in Robitussin DM) can provide relief
Additional Recommendations
- Stay hydrated with 8-10 glasses of water daily
- Use a humidifier at night to add moisture to the air
- Elevate your head while sleeping to reduce congestion
When to Consult a Healthcare Provider
If symptoms persist beyond 10-14 days, develop fever above 101°F, or include severe facial pain or green/yellow discharge, consult a healthcare provider as antibiotics may be needed for bacterial sinusitis, as indicated by the guideline evidence 1.
From the FDA Drug Label
The primary efficacy endpoint was the change from Baseline to Day 14 in the Total Nasal Symptom Score [TNSS] (the average of individual scores of runny nose, sneezing, itchy nose, and nasal congestion) as assessed by patients on a 0-3 categorical scale. Astelin® Nasal Spray significantly improved the TNSS. Astelin® Nasal Spray significantly improved a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing.
Azelastine (IN) can help with sinusitis runny nose and coughing problems by improving the Total Nasal Symptom Score (TNSS) and a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing 2.
- Key benefits:
- Improves TNSS
- Improves symptoms of rhinorrhea, post nasal drip, nasal congestion, and sneezing
- Note: While azelastine can help with runny nose and other nasal symptoms, its effect on coughing problems is not directly addressed in the provided text.
From the Research
Decongestant Options for Sinusitis
- Decongestants such as phenylpropanolamine, pseudoephedrine, and phenylephrine are commonly used to treat nasal congestion associated with sinusitis 3.
- However, the efficacy of these decongestants can vary, with phenylephrine being subject to first-pass metabolism and therefore not bioavailable in currently recommended doses 3.
- Phenylpropanolamine and pseudoephedrine have been shown to be effective decongestants, but can also increase blood pressure 4.
Treatment of Nasal Congestion
- Nasal congestion, regardless of its cause, responds well to decongestants 3.
- Topical decongestants can provide a faster and more intense decrease in nasal airway resistance, but may have a shorter duration and potential for rebound congestion 3.
- Oral decongestants, such as phenylpropanolamine and pseudoephedrine, can provide longer-lasting relief from nasal congestion 4.
Efficacy of Phenylephrine
- A study found that phenylephrine hydrochloride (PE HCl) at doses of up to 40 mg every 4 hours is not significantly better than placebo at relieving nasal congestion in adults with seasonal allergic rhinitis 5.
- This suggests that phenylephrine may not be an effective treatment option for nasal congestion associated with sinusitis.