Viral Rhinitis Flashcards
What is viral rhinitis?
“Common cold” or “runny nose”
Viral rhinitis is usually b______ and a ____-_________ viral infection.
Symptoms generally resolve untreated in ___-___ days.
benign
self-limited
10-14
What are two common viruses that cause viral rhinitis?
Rhinoviruses and coronaviruses
How does viral infections trigger viral rhinitis?
Why are the typical symptoms of viral rhinitis
Virus triggers immune system to release inflammatory mediators that cause common symptoms like rhinorrhea and nasal congestion
Does symptomatic treatment lessen the risk of complications?
No evidence
What are some complications that can develop from viral infections?
Middle ear effusions
Otitis media
Sinusitis
Asthma exacerbations
Febrile seizures (infants/children)
What’s the difference between the common cold and influenza?
Influenza/Flu (more severe):
- Abrupt onset of fever, severe myalgias, anorexia,, sore throat, headache, cough
- Caused by influenza virus
Common cold:
- Runny or stuffy nose, slight cough, headache, chills, sneezing, sore throat
-Caused by variety of viruses (including rhinoviruses and coronavirus)
What symptoms make COVID-19 stand out?
SARS-CoV-2 is more contagious than coronavirus strains that cause colds.
Influenza symptoms but with SOB, chills, and anosmia/dysgeusia
What symptoms may suggest the infection is bacterial?
Sinus headache
Difficulty breathing
Chest pain
What are non-pharms to prevent spread?
-Avoid close contact with someone who has the cold
-Wash hands (abstain from touching eyes or nose)
-Sneeze and cough into elbow or tissue
-Wear mask
Which OTC product has evidence for prevention of common cold?
North American ginseng extract (Panax quinquefolius)
- Cold FX
- Taken daily for up to 4 months
- May reduce upper respiratory tract symptoms by about 6 days
What is the main side effect with Cold FX?
GI upset
Does Cold-FX work for treatment of viral rhinitis?
No
Is Cold-FX safe in children?
No efficacy or safety studies in children
Do probiotics have evidence in the prevention of URTI?
Yes, if used for more than 3 months.
Should patients drink more water during common colds?
No, maintain usual fluid intake
Should patients get more rest during common cold?
Experts recommend rest, but no studies available to support
Is steam inhalation helpful for the common cold?
Insufficient evidence. Advise caution if using to prevent burns. Vaporizers should be cleaned regularly.
Does exercise reduce occurrence, severity, or duration of common cold?
Uncertain
What are the first line therapies for viral rhinitis? (3 classes)
- Analgesic and Antipyretics
- Anticholinergic
- Decongestants and Antihistamines
What are the drug choices for analgesic and antipyretics?
- NSAIDs (ASA, ibuprofen, naproxen)
- Acetaminophen
What ages can the following drugs be used in?
Acetaminophen
Ibuprofen
Naproxen
ASA
Acetaminophen (all ages)
Ibuprofen (≥6 months)
Naproxen (≥12 years)
ASA (≥18 years due to Reye’s syndrome)
How does acetaminophen and NSAIDs help with viral rhinits?
Acetaminophen= reduces fever
NSAIDs= improves pain-related symptoms (headaches, muscle/joint pain). Does not improve respiratory symptoms
What anticholinergic agent is used for viral rhinitis?
Intranasal ipratropium
What age can intranasal ipratropium be used in?
≥5y of age
Which symptoms do the intranasal ipratropium help with? What is the mechanism of action?
Helps with runny nose and sneezing.
Does not help with nasal congestion.
Blocks cholinergic-mediated vasodilation
What adverse effects are associated with intranasal ipratropium?
Nasal dryness, blood-tinged mucous, and epistaxis
What are examples of decongestants used in viral rhinitis?
-Pseudoephedrine (Sudafed)
-Oxymetazoline (Claritin, Dristan)
-Phenylephrine (Neo synephrine)
-Xylometazoline (Otrivin)
At what age are decongestants recommended for?
≥12 years of age
Are oral or intranasal decongestants recommended?
Intranasal
-faster symptom relief
-less adverse effects
If patient prefers oral, what are the two oral decongestants?
Pseudoephedrine
Phenylephrine
What is the difference between Sudafed and Sudafed PE?
Sudafed= pseudoephedrine (more effective)
- Requires pharmacy intervention
Sudafed PE= phenylephrine (not effective)
- Available over the counter
What do we have to watch out for with decongestants?
Rebound congestion
To avoid this, limit to short-term use (≤3 days)
Are antihistamines typically used alone in viral rhinitis?
No, they’re usually used in combo with a decongestant
At what age are antihistamine/decongestant combos recommended?
≥6 y of age
What are examples of antihistamine/decongestant products?
- brompheniramine/phenylephrine (Robitussin Children’s Cold)
- Dexbrompheniramine / Pseudoephedrine (Drixoral)
If patient does not want to use medicated therapies, what are three therapeutic alternatives?
- Saline Nasal Irrigation
- Honey
- Zinc Lozenges
How does saline nasal irrigation help with viral rhinitis?
Reduce nasal secretion and congestion
Reduce the need for decongestants
What is the saline concentration for saline nasal irrigation?
0.9% NaCl
Is saline nasal irrigation safe for children?
Yes. Infants who are obligate nose breathers may benefit from regular administration in general. Helps clean the nose.
What is the role of honey in viral rhinitis?
Unclear
Demulcent effects, may reduce cough
May improve sleep quality due to less cough
What is dosing for honey in viral rhinitis?
One teaspoonful (5mL) at bedtime
Is honey safe for children?
No, avoid honey in infants <12 months due to infantile botulism
What is the role of zinc lozenges?
Shortened the average duration of common colds by almost 3 days
What makes recommending zinc lozenges difficult?
Dosing is unclear
Unpleasant taste
Nausea
Which therapies have insufficient evidence in treatment of viral rhinitis?
- Antibiotics
- GI side effects
- increase abx resistance - Antitussives (codeine, dextromethorphan) and expectorants (guaifenesin)
- Avoid in <6 years
- Avoid codeine in <18 - Intranasal corticosteroids
- NHPs (including Cold-FX-> only good for prevention)
- garlic
- echinacea - Topical menthol as monotherapy or in combo with camphor and eucalyptus
- Avoid in <2 years old
- Increase production and decreased clearance of mucus leads to respiratory distress in children. Never place directly under or in nostrils
- Vitamin C
- Vitamin D
Is common cold or influenza a risk factor in pregnancy?
Yes, fever may be a risk factor for birth defects
How do you manage viral rhinitis in pregnancy?
- Antihistamines
- Decongestants
- Anticholinergics
- Vitamins and NHPs
- Antihistamines
- 1st generation (brompheniramine, chlorpheniramine, and diphenhydramine) are safe - Decongestants
- Oral (phenylephrine, pseudoephedrine) avoid in 1st trim due to malformation concerns
- Topical (oxymetazoline, xylometazoline) are safe if used ≤3 days - Anticholinergic no data
- Vit C: not recommended
- Echinacea: data not clear
- Ginseng: caution as teratogenic in animal studies
- Zinc: no data
How do we manage viral rhinitis in breastfeeding?
Saline and topical decongestants preferred.
Honey is safe.
First safe antihistamines and decongestants are safe (watch for s/e in infant like drowsiness and irritability)
What’s a counselling point to note about antihistamine and decongestant use in breastfeeding patient?
Especially when used in combo, it can reduce serum prolactin and reduce milk supply.
Use lowest effective dose and duration. Discontinue if decrease in breast milk production.
Can you walk me through the general management algorithm for viral rhinitis?
If patient has rhinorrhea or nasal congestion, start this algorithm
≤5 years -> fever (Y= Tylenol or Advil, N= saline nose drops for infants)
6-11 years -> fever (Y= Tylenol or Advil, N= consider oral antihistamine/decongestant for 3 days)
≥12y -> fever (Y= Tylenol, Advil, or Naproxen, N= topical decongestant for 3 days or topical anticholinergic for 4 days).
*If no symptom relief, oral decongestant/antihistamine for 3 days)
