Expert: Marc Rubin, RPh Asthma Educator - 3/4/2010

Question
QUESTION: I do not know where else to go with this since no expert is available under Allergy - Sinus and I did not see any EENT specialist. I am now in my mid 60's and have always (since early 20's) been plagued by an abnormally runny nose with physical activity. It is socially embarrassing. I first became aware of it being a problem playing on my college basketball team. While playing I would literally have to pull my jersey out of my trunks and use it to blow my nose; repeating the procedure as needed. When I go out dancing, my nose runs. If I go on a leisurely walk, my nose runs. If I am physically active with household chores, my nose runs. I do not see other people having the same issue under the same conditions. I realize it is rather late in my life to mention this but better late than never.
Q1.) Is my condition symptomatic of anything you are aware of?

ANSWER: Hi Mick,

I just returned from a conference, and one of the work-up cases was a patient with a persistant runny nose. From what I learned on this specific patient, I wish to rule out that this may apply to you. So I have a few questions to ask.

Do you develop any headaches prior to the runniness?
Are the watery secretions coming down through BOTH nostrils, or just one?
Have you ever been diagnosed with nasal polyps?

Get back to me on this please.


Sincerely,

Marc




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

QUESTION: Hi, Marc.
I have been taking the recommended Veramyst dosage (2 metered squeezes per nostril once daily) for 7 continuous days. I would say that so far the results are positive. My runny nose episodes seem to have dramatically been reduced. I can get thru my morning walk without blowing or wiping my nose. I intend to finish taking all of the sample container (30 sprays) that I have with a 2nd container available.
Q3.) Will I need to continue taking a nostril spray for the rest of my life or is it likely that I will go thru
       periods where the symptoms will clear for several months but reappear and therefore I will be
       on and off with the spray as needed?

ANSWER: Hi Mick,

Considering your 40 year history, unless you also experienced seasonal variations with the runniness, I'd expect that this will be with you from this time forward.

A couple of things, 1) generally, after a few days from reaching control, it is normal to reduce the dose to 1 spray in each nostril, once daily. IF the condition doesn't fl;are up again, you would stay at that dose, increasing for an occasional flare that may happen, and 2) new treatments are always evolving, and something better may come forward that is even easier to use.

As an alternative trial, the product Singulair has shown effectiveness in some patients with exercise induced asthma, when take 1 hour before the activity. If this would work for you, you would only need to medicate before you engage in activities that trigger the runniness.

Glad to see you have made improvement! The bottom line for a health care provider is success in achieving an improved quality of life, it is a win-win scenario for all.

One final note, it is extremely important that you spay the mist towards the outward flare of the nostril. If you spray straight up into the sinuses, you run the risk of nosebleeds or a fungal sinus infection. Technique is everything. Here is the company link:
http://www.veramyst.com/using_veramyst/how_to_use_veramyst_nasal_spray.html

Sincerely,

Marc

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

QUESTION: Marc,
I am afraid that my previous notes of reduced runny nose was premature. My nose is still running while continuing with the Veramyst. However, I am not sure that the spray is being delivered with each lever depression. I seem to "feel" the spray coming out of the bottle in some instances but not sure in others.

Answer
Mick,

You first need to gently shake the bottle, then spray. I like the product a lot, but I too sometimes have a difficulty in "snapping" that lever to get a good mist when I demonstrate the product. You may find that the medicine is dribbling down the side of the spray nozzle. If that is the case, wipe it, then do a re-spray. If this doesn't diminish the problem, I'd talk to the doc about the Singulair to add to it. If this combination is successful, I'd do a trial period without the Veramyst to see if Singulair alone can keep you in control.

Let me know how it goes.

Marc