The problem of addiction to nasal sprays is so widespread that the queen of chat devoted an entire show to the issue, writes DEREK SCALLY.
IT BEGAN for Alan seven years ago with a bad cold, a blocked nose and a trip to the chemist.
He came home with an over-the-counter nasal spray and, two squirts later, was amazed by its effectiveness.
“I was waking up in the night barely able to breathe and needed some relief. The spray worked immediately,” he says. When the next cold came, he reached for the bottle again, and again.
“At some point the cold was long gone and I had stopped using the spray but still woke up with a blocked nose, barely able to breathe. So I dug out the spray.”
He went through dozens of bottles until he decided enough was enough and went to his doctor.
“The doctor said it was a common complaint. First he gave me cortisone spray and then reduced it to a saline spray, which I still use occasionally today.”
Nasal obstruction and congestion is a common complaint, but one which can be severe enough to send sufferers looking for a solution in their local pharmacy.Many find relief in the humble nasal spray, one of the most controversial over-the-counter medicines going.
On the one hand, the spray does exactly what it promises: a few squirts and the swollen tissue in the nose shrinks, allowing in a blessed rush of fresh air.
But with that effectiveness comes a price: a vicious circle of overuse and dependence which, for some, can be difficult to break.
“Quick-acting nose sprays like Ultravene and Sinex do give instant relief but they can be habit-forming,” says Mr Peter Gormley, an ear, nose and throat (ENT) surgeon.
Just how dependent spray users become on the product is a hotly argued topic.
Internet forums dedicated to the topic have been debating the subject back and forth for years. Manufacturers deny their products have addictive qualities and point to the warnings they put on packaging against prolonged use.
Experts point out that the sprays contain no classic addictive substances, but concede that the relief the products provide can be habit-forming.
Just how hard it can be to kick the habit is clear from a quick trawl of internet forums.
The most common sprays work by constricting the internal network of blood vessels in the spongy mucous membranes in the nasal passages. In a nasal passage swollen by a cold infection, that has a near immediate effect of shrinking the tissue.
Experts say that, after a few days, these blood vessels soon become tolerant to the effects of the active ingredients in these sprays, generally phenlyephrine, oxymetazoline or xylometazoline.
The blood vessels eventually swell to an ever greater extent than before, aggravating the original symptom the spray was intended to resolve.
Users get shorter and shorter periods of benefit from the spray and can end up taking it all the time.
Prolonged use can cause serious damage to the delicate nose membrane, with the blood flow blocked entirely. The only relief: to reach for the spray.
Most ENT doctors prescribe nose sprays for the immediate period after nose surgery, but warn against prolonged use.
“Basically, you are interfering with the nose’s normal system, although the side effects are rarely dangerous over short periods,” says Gormley.
“But people taking a spray for years will experience permanent changes to the mucous membrane, the nerves and blood vessels in the nose.”
Excessive use of decongestant sprays can lead to a condition known as rhinitis medicamentosa, a permanent, spray-induced runny nose.
The problem is gaining increasing recognition worldwide, particularly after the US chat show queen Oprah Winfrey devoted an entire programme to nasal spray overuse.
The problem is in the news in Germany too, where some doctors attest to having at least one patient a day who cannot break their use of nasal sprays.
Four of the top 20 medications sold in German pharmacies are nasal sprays.
With an estimated 20-30 million bottles sold annually in Germany – one for every fourth member of the population – it’s a good business for the pharmaceutical industry.
A study by Germany’s state addiction office (DHS) found that at least 100,000 Germans use nasal sprays daily without suffering from a cold.
“The real usage figure is presumed to be much higher because it is harder to estimate with over-the-counter products,” says the study.
Doctors say that, depending on the length and frequency of use, it can take two weeks or more to break the dependency, often a miserable fortnight of poor sleep and a bunged-up nose during which most people will reach for the spray again for relief.
The easiest way to break the cycle, doctors say, is to buy sprays with a screw-top bottle and keep diluting the contents with saline solution.
Other former users recommend buying milder preparations for children, or spraying just one nostril.
In severe cases, a doctor may prescribe nasal steroids which control stuffed noses without any relapse risk or serious side effects.
After that, users can move on to an ordinary saline solution or use an nasal irrigation device to keep the nasal passage clear and moist.
“I had sprays beside the bed, in the bathroom, at work,” remembers Alan. “The only way to break the addiction is to throw them all out and not buy any more.
“For me, in the end, the side effects were worse than the original complaint.”
