'Congestion' means different things to doctors and patients

By Lisa Rapaport

By Lisa Rapaport

(Reuters Health) - Patients who say they're "congested" may have a runny nose, but a new study suggests their doctors may think they mean their nose feels blocked and treat them for the wrong symptoms.

Dr. Edward McCoul of the Ochsner Clinic Foundation in New Orleans, an ear, nose and throat doctor and the lead author of the study, explains that when congestion occurs in the nose, "the result is swelling (that) narrows the space for air to flow, and a patient would perceive this as a blockage or obstruction of airflow."


This can be treated with anti-inflammatory medicines to reduce swelling, McCoul said.

But when McCoul and colleagues surveyed 226 patients; 31 ear, nose and throat specialists and 28 physicians with other specialties about how they defined "congestion," the patients were much less likely to describe blockage in the nose or difficulty breathing.

Patients were more apt to say "congestion" meant symptoms like a drippy nose, mucus in the throat, pressure in the face, heaviness in the head or clogged ears.

"Medications that clear up mucus generally are not great at reducing swelling," McCoul told Reuters Health by email. "Many over-the-counter products are available that combine both types of medications, but using those products runs the risk of over-medication, which can have adverse consequences."

A variety of medications on drugstore shelves claim to relieve congestion, including expectorants, mucolytics, antihistamines and corticosteroids, the researchers note in JAMA Otolaryngology-Head & Neck Surgery.

Drug advertising probably adds to patients' confusion, said Dr. Michael Blaiss, executive medical director of the American College of Allergy, Asthma, and Immunology and a professor at the Medical College of Georgia in Augusta.

"We hear about chest congestion in ads; we hear about sinus congestion in ads; we hear about nasal congestion in ads," Blaiss, who wasn't involved in the study, said by email.

"So if the physician just asks about 'congestion,' it does not define for the patient the type of congestion," Blaiss continued. "This article should emphasize to the physicians to ask more pointed questions when the patient says they have congestion to truly know what the patient is truly complaining about."

Beyond its small size, other limitations of the study include the possibility that results could be different outside New Orleans, based on regional differences in the way people speak, the study authors note.

But the results aren't terribly surprising, said Ron Eccles, who studies the common cold at Cardiff University in the UK.

"I would be surprised if the terminology for both groups had a close match," Eccles, who wasn't involved in the study, said by email. "If patients are blocked with mucus and describe it as congestion then the doctor should be able to diagnose correctly after a proper examination of the nose."

SOURCE: https://bit.ly/2wGiUCM JAMA Otolaryngology-Head & Neck Surgery, online May 30, 2019.