Dr. Rehl’s 10 TIPS For Sinus and Respiratory Health This Fall and Winter

The time of year is upon us when blistering heat and monsoon winds give way to peaceful sunny 75 degree days.  With the change of seasons come a multitude of challenges for the nose, sinuses and lungs.  Allergens, dust, air pollution, particulate matter in the air, changes in barometric pressure and respiratory viruses can all wreak havoc on our respiratory systems leading to nasal congestion, post nasal drainage, cough, wheezing, fatigue and eventually sinusitis and bronchitis. 

The following 10 tips can help keep your nose, sinuses and lungs healthy this fall and winter.

1.  Stay hydrated.  Drink plenty of water to keep the mucous produced by your nasal, sinus and respiratory passages thin and flowing.  This will prevent stagnant mucous from building up in your sinuses and lungs.  When thick mucous is retained for long periods of time in the sinuses and lungs bacteria may flourish in that environment leading to sinus infection, bronchitis or pneumonia.  Adequate hydration by drinking water helps to prevent thick mucous.

2.  Rinse the nasal passages with saline solution.  Washing the nasal mucous membranes with saline solution eliminates irritating particles, allergens and thick mucous from the nose and sinus drainage passage ways.  Saline solution also stimulates the lining of the nose and sinuses to clean themselves better.  Little microscopic hairs called cilia move more frequently when exposed to saline resulting in egress of mucous from the nose and sinuses.  Many products are available over-the-counter to rinse the nose with saline including Neil Med® Sinus Rinse, Simply Saline® and Neti Pot™.  Remember to use distilled water to mix the saline rather than tap water or bottled drinking water. 1, 2

3.  Keep doors and windows closed on poor air quality days.  As the temperatures drop in the Valley it is tempting to open our homes to the more temperate desert air.  This can allow dust, air pollution and allergens to enter the home and our nose and lungs causing inflammation, swelling and increased mucous production.

4.  Change home air filters regularly.  Make sure your home HVAC filters are changed as directed to ensure they are actually removing the unwanted particles from the circulated air.

5.  Shower in the evenings.  Rinse unwanted dust, air pollution and allergens from your body and hair in the evenings.  This will prevent inhalation of undesirable particles from soiled pillows and bedsheets.  Lingering in a steamy shower will also help loosen mucous in the nasal passages and moisturize dry mucous membranes.

6.  Get adequate vitamin D.  Vitamin D deficiency has been linked to more frequent viral upper respiratory illnesses, allergic rhinitis, chronic sinusitis, nasal polyps and asthma. 3,4,5,6  Studies have also shown that vitamin D supplementation lead to decreased frequency of winter respiratory tract infections and asthma exacerbations. 7,8,9,10  Thirty to forty percent of Americans are vitamin D deficient. 11 We make vitamin D through the interaction of sunlight on our skin.  Our indoor lifestyles and use of sunblock prevent adequate vitamin D production in the skin and many folks, even in southern states, have vitamin D deficiency. 12, 13 Most adults and children take in less than 400 international units (IU) of vitamin D daily.  The Institute of Medicine recommends children and adults get no less than 600 IU of vitamin D daily.  The Endocrine Society recommends that children receive 1000 IU of vitamin D daily and adults 2000 IU daily.14  Risk factors for vitamin D deficiency include darker pigmented skin, winter season, sun avoidance, obesity, increasing age and use of certain medications including oral steroids and anti-seizure medications. 15 If you believe you are at risk for vitamin D deficiency, see your healthcare provider.  You may need over-the-counter supplementation of vitamin D or even prescription vitamin D replacement for very low levels.

7.  Get the sleep you need.  Lack of sleep increases your risk of getting sick after exposure to a virus.  Most adults need 7-9 hours of sleep.   Teenagers usually require between 8-10 hours of sleep while children require 9-11 hours. 16

8.  Consider an over the counter nasal steroid spray.  When your nose has been subjected to allergies or other airborne irritants and nasal congestion is not relieved and prevented with the above measures then consider using an over-the-counter nasal steroid spray as directed for 4-6 weeks.  These remedies are effective and relatively safe when used properly. 17,18,19,20  Be sure to aim the spray nozzle towards the internal sidewall of the nose rather than at the internal middle wall (septum).  Do not use the steroid spray until consulting with your physician if you have frequent nose bleeds, prior nasal surgery or glaucoma.  Discontinue the spray after 6 weeks unless you are under the care of a doctor who has recommended longer use.

9.  Consider over-the-counter remedies to relieve sinusitis symptoms.  Almost every grocery store or pharmacy has everything you need to find relief from uncomplicated mild acute sinusitis.  Symptoms of acute sinusitis include cloudy or colored nasal discharge, nasal congestion, nasal blockage, and pain, pressure or fullness in the face, head or around the eyes which have been present for 4 weeks or less.  Over-the-counter decongestant and mucous thinning combination tablets (ie. Mucinex-D ™) and over the counter decongestant spray (ie. Afrin ™-use for maximum of 3 days only) when combined with nasal saline irrigations during early and uncomplicated acute sinusitis can relieve symptoms and help resolve acute sinusitis.  Check with your healthcare provider if you have high blood pressure, heart disease, irregular heartbeat, prostate enlargement, urinary retention, frequent bladder infections, anxiety, nervousness or insomnia before taking over-the-counter decongestants as these medications can potentially worsen those conditions.  Also, it is very important to avoid using nasal decongestant spray for longer than 3 days.  Beyond 3 days of use the decongestant nasal sprays may cause long lasting irritation in the nose and worsen nasal congestion.  Most cases of acute sinusitis will resolve without antibiotics.  If symptoms last more than 7 days after starting over-the-counter treatment then it is time to see your healthcare provider to determine the appropriate course of action.  At that point antibiotics may be prescribed.  Keep in mind oral antibiotics have potential harmful side effects including nausea, rash, stomach upset, diarrhea, allergic reaction, causing resistant germs and ridding our body of essential helpful bacteria in the digestive tract. 21

10.  Continue to exercise if your symptoms are mild and you have the energy to do so.  Avoid exercise if you have shortness of breath, significant cough or any other chest symptoms.  However, if you have mild nasal and sinus symptoms (congestion, pressure) aerobic exercise can bring relief.  Aerobic exercise results in the release of epinephrine (adrenaline) into your blood stream. This epinephrine release acts as a natural nasal decongestant by constricting blood vessels in the inflamed and swollen tissues in the nose and sinuses.  After a few to several minutes of aerobic exercise the nasal passages usually feel clearer.  Additionally the repetitive bouncing or vibrations the body experiences from aerobic activity like running and high intensity interval training transmits vibrations to the sinus cavities and lungs which some experts believe helps with clearance of thick mucous from those passages.  Natural clearance of mucous from the sinuses by cilia (microscopic hairs which line the mucous membrane and sweep mucous out of the sinus cavity) increases during exercise. 22 Remember to stay well hydrated when you exercise and when you have nasal and sinus symptoms.  It is recommended you double your normal water intake to prevent dehydration during exercise in the setting of mild upper respiratory symptoms.  Please be respectful of others and avoid group fitness and gyms if you believe you have a contagious viral or bacterial illness.  Once symptoms have resolved you may return to the gym.  Remember there are plenty of exercise activities you can do on your own without heading to a fitness class or gym.

I hope the preceding 10 recommendations keep you feeling clear headed, vibrant and healthy this fall and winter.  If your respiratory symptoms persist beyond 7 days despite the measures above, or if you have shortness of breath, consult with a qualified healthcare provider or physician.

Ryan M. Rehl, M.D.

Founder, Arizona Sinus Center
a Division of Valley ENT, P.C.
www.arizonasinus.com

Immediate Past President Arizona Society of Otolaryngology-Head and Neck Surgery

References:

1.  Rudmik L, Hoy M, Schlosser RJ, et al. Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2012
2.  Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2007
3. Belderbos M. Oral presentation. 7th International Respiratory Syncytial Virus Symposium. December 2010 (Netherlands)
4. Ginde et al.  Third National Health and Nutrition Examination Survey. Arch Intern Med 2009;169:384–390.  
5. Stokes P, Rimmer J. Am Journal of Rhinol Allergy 2016 30(1)
6. Schlosser et al.  Int Forum Allergy Rhinol. 2016;6:58-65
7. Linday et al.  Annals of Otology, Rhinology & Laryngology. 113(11):891-901, 2004 Nov.
8. Urashima et al.  Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.  Am J Clin Nutr 2010;91:1255–1260.
9. Majak P, Olszowiec-Chlebna M, Smejda K, Stelmach I. Vitamin D supplementation in children may prevent asthma exacerbation triggered by acute respiratory infection. J Allergy Clin Immunol 2011;127:1294–1296
10. Linday et al.  International Journal of Pediatric Otorhinolaryngology 2004 68 (6).
11.   Holick et al.  J. Clin. Endocrinol. Metab. 2012, 97, 1153–1158.
12.   J Clin Endocrinol Metab 2005; 90:1557– 62.
13.   Am J Clin Nutr 2008;87:608–13
14.   Holick, M.F., Wacker M. Vitamin D—Effects on Skeletal and Extraskeletal Health and the Need for Supplementation Nutrients 2013, 5, 111-148
15.   Holick, M.F. The vitamin D deficiency pandemic: A forgotten hormone important   for health. Public Health Rev. 2010, 32, 267–283.
16.   www.mayoclinic.org
17.   Snidvongs K et al. Topical steroid for chronic rhinosinusitis without polyps.   Cochrane Database Syst Rev. 2011;(8)
18. Kalish L et al. Topical steroids for nasal polyps. Cochrane Database of Systematic Reviews 2012, (12)
19.   Joe SA et al. A systematic review of the use of intranasal steroids in the   treatment of chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2008;139:340–347
20.   Meltzer et al. Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. The Nasonex Sinusitis Group. J Allergy Clin Immunol 2000;106:630 –7.
21.   Clinical practice guideline: Adult sinusitis  Otolaryngology–Head and Neck   Surgery, Vol 137, No 3S, September 2007  
22.   Cohen NA. Sinonasal mucociliary clearance in health and disease.  Annals of Otology, Rhinology, & Laryngology - Supplement. 196:20-6, 2006 Sep.

 For additional information on sinusitis:
www.entnet.org