From the Guidelines
For inpatient management of dry nose and bloody sputum during winter, saline nasal sprays and humidification are recommended as first-line treatments [ 1 ]. Medications such as oxymetazoline 0.05% nasal spray may be used for up to 3 days to help reduce nasal congestion, while normal saline nasal irrigation with a neti pot or squeeze bottle can be performed 2-3 times daily [ 1 ]. In cases of persistent bleeding, nasal packing or application of petrolatum-based ointments may be considered, and in severe cases, oral decongestants such as pseudoephedrine 30-60 mg every 4-6 hours may be prescribed for a limited duration [ 1 ].
Key Considerations
- Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis [ 1 ]
- Intranasal antihistamines may be used as an alternative for first-line treatment of allergic and nonallergic rhinitis [ 1 ]
- Leukotriene receptor antagonists may be considered in patients with concurrent diagnosis of mild persistent asthma [ 1 ]
- Patient education is essential to provide the best care for the patient with rhinitis, including knowledge of and sensitivity to the cultural, socioeconomic, and demographic characteristics of the patient [ 1 ]
Medication Options
- Oral antihistamines: such as loratadine, desloratadine, and fexofenadine, which are preferred over first-generation antihistamines due to their reduced sedation and anticholinergic effects [ 1 ]
- Intranasal corticosteroids: such as fluticasone propionate, which are the most effective medication class for controlling symptoms of allergic rhinitis [ 1 ]
- Intranasal antihistamines: such as azelastine, which may be used as an alternative for first-line treatment of allergic and nonallergic rhinitis [ 1 ]
From the FDA Drug Label
Purpose: Nasal Decongestant Principal Display Panel Compare to Sudafed® Congestion active ingredient Pseudoephedrine Hydrochloride, 30 mg Nasal Decongestant MAXIMUM STRENGTH Uses • temporarily relieves sinus congestion and pressure • temporarily relieves nasal congestion due to the common cold, hay fever or other upper respiratory allergies
The appropriate inpatient medication for dry nose (rhinitis) exacerbations during the winter season is oxymetazoline (IN), a nasal decongestant 2. For hemoptysis (bloody sputum), there is no information in the provided drug labels.
- Pseudoephedrine (PO) may be used to relieve sinus congestion and pressure, and nasal congestion due to the common cold, hay fever, or other upper respiratory allergies 3 3. However, pseudoephedrine (PO) does not directly address hemoptysis (bloody sputum).
From the Research
Inpatient Medications for Dry Nose (Rhinitis) and Hemoptysis (Bloody Sputum) Exacerbations
- For dry nose (rhinitis), nasal decongestants such as pseudoephedrine and oxymetazoline can be used to alleviate symptoms 4.
- However, the effectiveness of nasal decongestants in children and the clinical relevance of their small effect in adults is yet to be determined 4.
- Topical decongestants like oxymetazoline can be used for an extended period of 4 weeks without significant increases in subjective nasal blockage or impaired decongestant response 5.
- On the other hand, long-term use of xylometazoline nasal spray can shorten the decongestive response and induce rebound swelling 6.
- For hemoptysis (bloody sputum), there is no direct evidence from the provided studies to support a specific medication.
- However, nasal irrigation with hypertonic saline can be effective in improving nasal symptoms and ciliary movement in patients with chronic rhinosinusitis 7.
- Additionally, normal saline nasal spray can provide additional benefit in symptomatic relief and clinical improvement when added to standard treatment regimen of chronic rhinosinusitis 8.
Considerations for Inpatient Treatment
- The choice of medication should be based on the individual patient's condition and medical history.
- It is essential to monitor patients for potential adverse effects and rebound congestion when using nasal decongestants 4, 6.
- Nasal irrigation with saline solutions can be a useful adjunctive treatment for patients with rhinitis and chronic rhinosinusitis 7, 8.