Keeping symptoms of winter congestion and coughs at bay
Ask the GP...
Advice from our GP on hay fever symptoms in winter and how to manage croup.
Question: My son has a runny nose all the time. He constantly has to carry tissues. I know this sounds like hay fever but it's winter. What is this?
Dr Nina replies: Your son does indeed have hay fever, only it's not hay causing the problem. Allergic rhinitis is the medical term for this. It causes a sensation of blocked nose, congestion and can cause sneezing, itchy eyes and nasal drip. Other symptoms include reduced taste, red eyes, mouth breathing, snoring, reduced sleep and fatigue.
Most associate rhinitis with summer grasses and pollens but symptoms can occur seasonally for some or all year round for others. Common triggers in winter months are house dust mite, moulds, fungal spores and animal dander. Rhinitis occurs in about 20pc of the population. It affects all ages. It is more common in those with a personal or family history of asthma or eczema.
Treatment involves firstly reducing exposure to the triggers. Carpets and blow heaters will harbour and circulate dust and spores and should be avoided. If it is impossible to avoid your triggers then using a daily nasal rinse may help.
There are many available over the counter in pharmacies. Used correctly these can flush dust, spores and irritating mucus from the nasal passages, helping to keep them clear.
Medication can help. Antihistamines reduce the body's allergic response, helping to limit the congestion, swelling and nasal drip associated with rhinitis. It is preferable to use those that are less sedating by day, but a sedating one may have benefits if taken at night as disturbed sleep can be a feature of rhinitis. Steroid nasal sprays are essentially the mainstay of treatment for rhinitis whenever it occurs.
They act locally in the nasal passages so absorption into the body is minimal. They help reduce swelling in the nasal passages, thus reducing congestion and blockage.
Steroid nasal sprays are generally considered safe and they can be used on an ongoing basis if required.
Over-the-counter dwwecongestants such as pseudoephedrine are a popular remedy but they should only be used short term. Prolonged use of these can make symptoms worse in the long run.
It is important that remedies are used in the correct way and the correct order. If your nasal passages are very inflamed, using a decongestant such as pseudoephedrine or stronger steroid nasal drop for a few days before starting the nasal spray may render the spray more effective.
Pseudoephedrine, however, should never be used for more than a few days and should only be used under medical or pharmacy advice as it isn't suitable for everyone.
When using a nasal spray, aim straight back into the nose and breath normally after using it.
Snorting the spray back delivers it to the throat, reducing its efficacy. If sprays, rinses and antihistamines aren't working, there are other prescription options and it is worth talking to your doctor or requesting referral to attend an allergy specialist for these.
Question: My daughter had a barking cough which got worse in the evening. The crèche said they thought she had croup, but to me it just seemed like a virus that did go away. What is croup and should I have been concerned?
Dr Nina replies: Croup is an infection of the upper airway that results in inflammation and causes a characteristic barking cough. It is most commonly caused by circulating respiratory viruses. Children aged six months to three years are most commonly affected. The wind pipe becomes firmer and wider as they get older, making it uncommon over the age of six years.
Symptoms usually start like the common cold with a runny nose, possible fever and blocked nose. As inflammation increases, the cough becomes more coarse and bark-like. In more severe cases, a noise may occur on breathing in. This is called stridor and is a sign that significant inflammation is present. Symptoms tend to be worse at night or when a child is irritated or crying.
Most cases of croup are mild and can be managed at home. Symptoms peak at around day two to three and last largely between three and seven days.
Breathing moist air may help. Parents will often sit a child in a bathroom while the shower is running but direct exposure to steam is dangerous and should be avoided.
Treating fever and keeping the child comfortable will help. Going outside to cold air helps in some cases. Give the child plenty of drinks as the rapid breathing, fever and coughing make them more prone to dehydration. In more severe cases steroid tablets may be required. These are given as a daily dose for up to three days. They reduce inflammation, making breathing easier.
About one in 10 children require hospital treatment for croup. Signs to watch out for include very rapid shallow breathing with tugging of the muscles of the neck and chest, unusual fatigue, restlessness or agitation. If any of these occur, seek medical advice straight away.
Health & Living