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Nasal sprays can bring on a vicious cycle
FAST RELIEF: A woman blows her congested nose

Very few drugs relieve a symptom as speedily as an over-the-counter decongestant nasal spray clears a stuffy nose. A couple of squirts can shrink swollen tissues in seconds to minutes, letting in an exhilarating rush of fresh air. With some sprays, a single dose works for as long as 12 hours.

But relief provided by nasal spray decongestant like Afrin and Neo-Synephrine comes at a price: the risk of rebound congestion caused by overuse and, for some people, a vicious cycle of overuse and dependence that feels like an addiction. “It works so well that you tend to keep using it,” says Dr David Vernick, an ear, nose and throat specialist at Beth Israel Deaconess Medical Center in Boston. “You’re used to breathing well with the spray, and when you stop it, you get congested. So you use it a little more frequently, yet the congestion doesn’t clear up for long.”

That’s because after three or four days of continuous use, the sprays can cause the nasal linings to swell up again, even when the cold or attack of sinusitis or allergy that originally caused the problem has passed. If this pattern continues, a patient has a good chance of becoming trapped in a vicious cycle of overuse and dependence that can last for months or years.

Confessions of nasal spray addiction now crop up regularly on Internet discussion forums: one site, afrinaddiction.com, markets a book of tips for kicking the habit.

Clayton Traylor, who started the Web site in 2005, said he had used nasal spray “off and on” for chronic sinus trouble since he was a child. “I got addicted many times, quit cold turkey and then started back again,” said Traylor, who lives in Birmingham, Alabama.

Whether a dependence on nasal sprays is a true addiction is arguable, but some doctors point out that, as with drugs of abuse, people who are hooked on nasal decongestant tend to use more and more and to suffer withdrawal symptoms if they try to stop.

“It’s pretty common,” says Dr Neil Bhattacharyya, associate professor of otology and laryngology at Harvard and Brigham and Women’s Hospital. He added: “I’d say that one out of every seven patients with sinus and nasal obstruction have abused nasal sprays. They say it’s the only way they can sleep at night.”

Doctors call nasal stuffiness and blockage that are caused more by the treatment than the original problem rhinitis medicamentosa, a term coined in 1946. The problem can easily fly under the radar of a standard medical exam, said Dr Stanley Goldstein, an allergist in Rockville Centre, New York.

“Often the patient doesn’t mention a nasal decongestant when listing his medications, because it’s over-the-counter,” Goldstein said. He says he diagnoses the disorder several times a month in his practice. “You have to ask them,” he said, “and ask how many bottles they have. They’ll have them everywhere, in the house, in their car, in their briefcase, in their desk. They cannot function without the drug.”

Goldstein recalled a patient who admitted going through the host’s medicine cabinet at a party until she found a bottle.

NOSE JOB: Extended use is discouraged

Rebound congestion is a risk with decongestant that contain one of two compounds that shrink spongy, swollen nasal membranes by constricting the network of tiny blood vessels within them.

Phenylephrine, a short-acting vasoconstrictor, is the active ingredient in Neo-Synephrine, a medicine cabinet staple since it entered the market in 1940. A longer-acting compound ' oxymetazoline and xylometazoline ' appeared in the 1960s and is responsible for Afrin’s advertised 12-hour relief. (There is also a formulation of Neo-Synephrine containing oxymetazoline.) “Afrin is safe and effective when used for three days,” said a spokeswoman for its maker, Schering-Plough. “We do not support extended use of this product.”

Though it is not entirely clear why, the blood vessels in the nasal lining quickly become tolerant to the drugs’ shrinking effects. With months of overuse, the sprays choke off blood flow to the nasal membranes and damage them. In some patients with severe cases, Bhattacharyya said, “the inside of their nose looks like a chemical burn”. Goldstein said he had seen patients with holes in the nasal septum ' the structure that separates the two breathing passages ' from abuse of the decongestant.

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