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General measures that allow mucus secretions to pass more easily may be recommended when it is not possible to determine the cause. Many people, especially older persons, need more fluids to thin out secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (medications that increase urination) will help. Mucous-thinning agents such as guaifenesin (Humibid®, Robitussin®) may also thin secretions. Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day either with a nasal douche device or a Water Pik® with a nasal irrigation nozzle. Warm water with baking soda or salt (½ to 1 tsp. to the pint) or Alkalol®, a nonprescription irrigating solution (full strength or diluted by half warm water), may be helpful. Finally, use of simple saline (salt) nonprescription nasal sprays (., Ocean®, Ayr®, or Nasal®) to moisten the nose is often very beneficial.
My preference is to prescribe a short course of oral steroid which is tapered (reduced gradually) every two days for a total of ten days. A nasal steroid spray is prescribed for long-term use. The nasal steroid sprays are not addictive and may help to maintain good airflow through the nasal passages as the oral steroid is eliminated. The patient is instructed to stop the TND within two days, allowing time for the oral steroid to take effect. If there is no history of blood pressure elevation, heart, thyroid or eye problems, an oral decongestant (. Sudafed) may also be recommended. I also recommend nasal saline rinses.