Sinus and Nasal Problems Sinuses are spaces or air cavities found within the skull which connect with the nose. Their function is to filter and moisten the air that we breathe, give resonance to our voices, and make the skull lighter. Various sinus-related conditions may occur. Persistent allergic rhinitis Symptoms occur continuously rather than seasonally as in intermittent allergic rhinitis (see Hay Fever). However, they may worsen during pollen season. Nasal congestion is more common and sense of smell may be lost. Sneezing is less than with hay fever, although sinusitis occurs more often. The eyes are usually unaffected. Persistent allergens, such as house dust mites, moulds and animal dander are the typical causative agents, and should be avoided if possible. Wooden flooring should replace carpets and allergen-impermeable bed linen should be used. Treatment is with OTC antihistamines, corticosteroids and decongestants. Sinusitis Sinusitis occurs when the sinuses become inflamed or infected, and the congestion that results is unable to drain, causing pain. Often associated with a cold (see Colds), symptoms may also include headache or apparent toothache. Sinusitis can be acute or chronic, and antibiotics may be needed if the cause is due to a bacterial infection. Infective rhinitis This is often associated with the common cold (see Colds) and is usually viral in origin. Symptoms such as coloured nasal discharge, cough and/or sore throat typically resolve within a few days. Vasomotor rhinitis Symptoms of vasomotor rhinitis are similar to those of allergic rhinitis, and often get worse with seasonal changes. Allergy testing will give a negative result. Certain odours, such as perfume, cigarette smoke and paint fumes, alcohol, spicy foods, environmental factors (eg, temperature, barometric pressure) and bright lights may also exacerbate or “trigger” the symptoms. The nose can be either really runny, or dry and congested. Base choice of topical nasal treatment product on symptoms. Nasal foreign body Anybody with an object trapped up their nose should see a doctor if the object cannot be dislodged easily. For parents, sometimes the first sign in young children is a smelly discharge leaking from one nostril. Seek medical advice rather than attempting self-removal. Keep toys with small parts, or other items (such as beads) out of reach of young children at all times. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Does the person also have shortness of breath, a cough or wheeze? • Are there any other symptoms (eg, swollen glands, fever and/or a persistent headache)? • Is there any coloured or yellow discharge from the nose or eyes? • Is only one side of the nose or eye affected? • Could a foreign body be trapped up the nose that cannot be easily dislodged? • Have the nasal symptoms come on soon after beginning a new medication? • Are the ears or sinuses painful? • Have symptoms persisted despite treatment? • Is the person a child? • Does the person have any allergies to topical medicines? or vasomotor rhinitis and refer any customers with "yes" answers to the Refer to Pharmacist questions. For other customers, base product selection on most troublesome symptom, for example: • itchy eyes: an antihistamine eye drop • blocked nose: an oral decongestant • runny nose: an oral antihistamine • sinus pain: an oral analgesic and possible referral to a doctor. Initial assessment The time of the year and a person's symptoms should give you some clues as to their most likely condition. Offer lifestyle advice to people suffering from allergic ACTS IN 5MINS Voltaren Rapid 25 390x45.indd 2 Page 134 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
CONTINUING OTC EDUCATION TREATMENT OPTIONS Category Examples Comments Oral antihistamines Topical (nasal and ocular) antihistamines, nasal corticosteroids Nasal corticosteroids Decongestants Combination products (contain analgesics) Non-sedating [PHARMACY ONLY MEDICINE] eg, cetirizine (Razene, Allerid-C, Histaclear, Zetop, Zyrtec), desloratadine (Aerius), fexofenadine (Hayfex, Fexoclear, Telfast, Xergic), levocetirizine (Levrix), loratadine (Loraclear, Lorafix) Sedating [PHARMACIST ONLY MEDICINE] eg, dexchlorpheniramine (Polaramine), promethazine (Phenergan) [PHARMACY ONLY MEDICINE] eg, levocabastine (Livostin Eye Drops/Nasal Spray), naphazoline + pheniramine (Naphcon-A, Visine Allergy), naphazoline + zinc (Clear eyes-A), naphazoline + antazoline (Albalon A Allergy), ketotifen (Zaditen) [PHARMACY ONLY MEDICINE] eg, beclomethasone (Alanase, Beconase Allergy & Hayfever), budesonide (Butacort), fluticasone (Flixonase Hayfever & Allergy), triamcinolone acetonide (Telnase) Topical (nasal) [PHARMACY ONLY MEDICINE] eg, oxymetazoline (Drixine No Drip, Sudafed Nasal Spray*), xylometazoline (Otrivin range) Oral [GENERAL SALE] eg, phenylephrine (Sudafed PE Nasal Decongestant*) [GENERAL SALE] or [PHARMACY ONLY MEDICINE] eg, ibuprofen + phenylephrine (Nurofen Sinus Pain) eg, paracetamol + phenylephrine (Dimetapp range, Sudafed PE Sinus + Pain Relief*) eg, paracetamol + phenylephrine + chlorpheniramine (Dimetapp PE Sinus Pain + Allergy, Sudafed PE Night*, Sudafed PE Sinus + Allergy & Pain Relief*, Sudafed PE Sinus Day + Night Relief*) Useful for symptoms that persist during the day. Although drowsiness with these products is rare, it may still occasionally occur in some people. Always caution about driving or operating machinery if feeling drowsy. May not be suitable for children of certain ages. May be useful to aid sleep when symptoms are more problematic at night. Warn about drowsiness and the risk of driving or operating machinery. Refer to the pharmacist people on medicines, or with certain health conditions, since these products may not be suitable for them (see Reference section, OTC Interactions, Precautions). Avoid alcohol. These are [PRESCRIPTION ONLY MEDICINES] for children under two years old. Have a localised effect and a rapid onset of action. Many eye drops may not be suitable for use with contact lenses – check instructions. Use eye drops combining antihistamines with decongestants short term only (ie, less than three days). Throw drops away one month after opening. Stinging and a bitter taste after application have been reported. Useful for treatment and prevention and as a first-line therapy for moderate-to-severe allergic rhinitis. A decongestant or antihistamine may also be required initially on starting a nasal corticosteroid as relief may be delayed two to three days. Best reserved for when nasal congestion needs to be treated quickly. Useful for symptom relief while waiting for nasal corticosteroids to take effect. Rebound congestion can occur with extended use. Topical decongestants should not be used longer than three days. Do not use in children aged under two years unless on medical advice. Decongestants dry up a runny nose. May not be suitable for some people (see Reference section, OTC Medicines – Precautions). Some products are also not recommended for children under six, see Colds. Watch for double-dosing if taking more than one product. May be useful for periods where symptoms are particularly bad. Watch for double-dosing of decongestant ingredients if taking more than one product. Some products are not recommended for children under six, see Colds. Other nasal products Natural / herbal products / supplements [GENERAL SALE] eg, cellulose and peppermint powder (Nasaleze) eg, saline (Otrivin Clear Saline Plus, Fess Nasal range) eg, Neil Med Naspira Nasal-Oral Aspirator Cowslip, elderflower, sorrel, verbena, bromelain, quercetin, Sanderson Sinus & Allergy Cellulose powder is delivered as a fine mist into the nasal passages where it forms an impermeable barrier to allergens. Saline thins nasal mucus and moisturises dry nasal passages. It allows mucus to break down faster and washes away pollen, animal dander and dust. Nasal-oral aspirators allow nasal mucus to be removed efficiently. A combination of cowslip, elderflower, sorrel and verbena reduces symptoms of acute and chronic sinusitis. Other natural products (eg, bromelain, quercetin) may also help. Products with an asterisk have a detailed listing in the Sinus & Nasal Problemssection of OTC Products, starting onpage 258. Otrivin nasal spray (xylometazoline HCl 1 mg/mL). Pharmacy Medicine. For short-term relief of nasal congestion caused by colds, flu, sinusitis or allergies. Do not use if allergic to any ingredient, after operations through the nose or mouth, with narrow angle glaucoma or in children under the age of 12. Common side effects: brief stinging sensation or sneezing. Otrivin is a trademark owned by or licensed to the GSK group of companies. GSK Auckland, NZ. TAPS PP9527. CHANZ/CHOTRI/0012/17. 10/04/17 5:17 pm Page 135
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
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