Chronic stuffiness could be rhinitis
Dear Doctors: What causes nasal stuffiness when you don’t have a cold or allergy? My nose sometimes gets stuffy when I lie down, then clears up when I stand. Blowing my nose yields nothing. Even when I have a cold, it will open up if I exercise. What can help when you have a stuffy nose?
Dear Reader: The stuffy nose you have been dealing with is called rhinitis. “Rhino” refers to the nose, and “itis” indicates the presence of inflammation.
In addition to congestion, symptoms of rhinitis include sneezing, nasal itching, reduced sense of smell and a runny nose. The condition can be classified as allergic and nonallergic rhinitis. As the name plainly states, allergic rhinitis arises from an immune response to the presence of an allergen. Nasal inflammation with no apparent cause is referred to as nonallergic rhinitis. Being stuffed up from a cold or the flu also falls under that category.
The nasal cavity is served by a dense and complex network of blood vessels. It is also lined with a thin layer of mucus that keeps the tissues moist and flexible, and which contains immune cells that defend against foreign invaders. When something causes the blood vessels in the nasal passages to become inflamed, they swell up. This leads to congestion that can range from mild to severe. When the tissues swell, they also slow the flow of mucus. As mucus accumulates, it can contribute to stuffiness.
It also appears that certain immune cells within the nose can trigger an inflammation response, even when infection or allergens are not present.
Nonallergic rhinitis has a wide range of triggers. They include potential irritants such as perfumes; cleaning products; secondhand smoke, smog or other air pollutants; spicy foods; hot beverages; changes to the weather; hormonal fluctuations; pet dander; dry air; and certain medications.
While nonallergic rhinitis can also include an overproduction of mucus, it is not always present. When congestion is due mostly to swelling and not to an abundance of mucus, as in your case, blowing the nose brings no relief.
As many people with a chronic stuffy nose know, lying down can make things worse. That’s because while you’re upright, gravity helps your sinuses drain. But when you lie down, the effect is negated, and congestion occurs. Elevating your head — whether with pillows or by sitting or standing up — increases nasal drainage, often quite quickly. The increase in blood circulation that comes with light exercise can also widen the nasal passages, which makes breathing easier.
If your doctor has ruled out allergy, infection or sinus problems as a cause, there are steps you can take to get relief. Using a humidifier can be helpful, as can saline sprays. You also can use a daily saline rinse, but, as we have written in previous columns, always be sure to use sterilized water. Antihistamine sprays and decongestants can reduce symptoms, but their effect is temporary. Some people find that external nasal dilator strips, which manually open the airways, make breathing easier. They can be particularly helpful when sleeping.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.