[Decongestants in treatment of nasal obstruction]

Decongestants have long been used in nose obstruction. On the one hand they seem to be abused in local treatment, on the other they are too rarely used in initial treatment of other pathological states of the nose. Yet, as the knowledge of the nasal mucosa vascular system and its neurological and humoral regulation increases, there appear broader indications for their application. A more frequent use of the drugs could be suggested in infectious and allergic rhinitis and paranasal sinusitis, where their application prevents complications and enhances the efficacy of treatment. The sympathomimetic drugs are recommended in rhinitis because a reduction of nasal congestion permits the introduction of other topical therapy such as nasal corticosteroids. They are also recommended in rhinitis during pregnancy and diagnostic procedures in some cases of structural rhinitis. This article briefly discusses the relationships between the nasal mucosa vascular system, the autonomic nervous system and neuropeptides in the regulation of air flow in the nose. Regarding their use in rhinitis treatment, there were characterized groups of sympathomimetic vasoconstrictor agents, which include sympathicomimetics (e.g. phenylpropandamine, phenoloephedrine) and alpha-receptor agonist medications (e.g. xylometazoline, oxymetazoline, naphazoline). The author discussed the pathomechanism of rhinitis medicamentosa resulting from abuse of nasal drops containing alpha-agonists and suggested a therapy.