Expert: Marc Rubin, RPh Asthma Educator - 12/20/2010

Question
QUESTION: Dear Marc Rubin

i am suffering from allergic rhinitis, post nasal drip and feel some mucus in chest when wake up early in morning. can post nasal drip go into chest when sleeping, is it normal mucus chest in morning.

Regards
Zafar Iqbal

ANSWER: Hello Zafar,

Yes, this would be normal.

Overnight, the chemicals your body produces to reduce inflammation (corticosteroids) drop significantly. This results in an increase in inflammation in susceptible individuals during the early morning hours (~3am to 6am). The response is increase in secretions.

You may wish to speak to your doctor about starting either a steroid nasal spray, such as fluticasone, to be used on a daily basis, or, as a trial, montelukast, a tablet taken every night at bedtime that, in many cases, dramatically reduces the inflammatory chemicals. It works in about 40% of the patients.

Let me know what happens. If you get the nasal spray, get back to me so I can send you an instruction guide on proper technique so to reduce the risk of side effects.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Dear Marc Rubin i have been using nasal sprays and montelukast, cetrizine on regular basis from five years but did not see improvement. sometime i also feel breathing problems i checked a chest physian who said it ok and breathing problems due to depression and panic attacks because i have been suffering from depression and using antidepressants. can mucus secretion be in chest in morning without allergies?

Regards
Zafar Iqbal

ANSWER: Hi Zafar,

What antidepressant meds does y9ur doctor have you on? Some may be contributing to this problem.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Dear Marc Rubin currently i am using sertraline 100 mg and gabapentin 600 mg daily, for allergic rhinitis cetrizine and montelukast daily.

Regards
Zafar Iqbal

Answer
Hi Zafar,

The sertraline can cause the runny nose, leading to your problems. I would discuss with your physician changing to bupropion for your situation instead of sertraline.

Also,what is your home & work environment? Do you have a wood-burning stove or fireplace at home? Are you near any factories that emit a lot of air pollution?

Talk to you soon.

As a side note, bupropion has less of an impact on sexual function than sertraline. If this potential side effect of sertraline is affecting you, it may contribute to your ongoing depression.

Sincerely,

Marc